PBM Implementation Pharmacist
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Job Description
PBM Implementation Pharmacist leading clinical setup of Pharmacy Benefit Management accounts and serving as a clinical SME. Collaborating with pharmacy and engineering teams to ensure accurate implementations and configurations.
Responsibilities:
- Serve as the primary clinical SME on pharmacy implementations
- Lead clinical and drug reference domains on pharmacy design, development, and implementations (DDIs)
- Be a primary point of contact with the state client pharmacy team during the DDI and hypercare phases
- Ensure benefit plan drug coverages are configured accurately to state client specifications and requirements
- Validate successful and accurate conversion of pharmacy data from other vendors and stakeholders
- Ensure all point‑of‑sale (POS) claims processing edits, pricing, return messaging, and configuration meet the business requirements of the client
- Work with engineering and pharmacy business analyst teams to configure automated PA rule sets and electronic prior authorization (EPA) question sets, including testing scenarios and validation with the client
- Track and document progress of clinical domain activities against requirements and timelines, and provide status reports to senior leaders
- Identify risks or issues, ensure they are documented and tracked, and work with appropriate stakeholders to resolve them
- Maintain a clear understanding of the operational readiness, certification, and delivery status of all Gainwell pharmacy implementations
- Provide subject matter expertise for pharmacy and drug rebate product development, sales pursuits, RFP responses, and DDIs
- Encourage and strengthen cohesiveness and team unity across the pharmacy business and stakeholders on all Gainwell pharmacy implementations
- Participate in corporate pharmacy team meetings
Requirements:
- Active pharmacist license is required
- Minimum of five (5) years of experience in pharmacy benefit management
- Minimum of three (3) years of experience working with a Medicaid PBM account
- Detailed knowledge of Medicaid at the state and federal level
- Experience and knowledge of NCPDP standards and point‑of‑sale (POS) pharmacy claim processing is required
- Experience and knowledge of First Databank (FDB) drug hierarchies, drug reference files, and prospective DUR parameters is required; understanding of Medispan hierarchies is preferred
Benefits:
- generous, flexible vacation policy
- 401(k) employer match
- comprehensive health benefits
- educational assistance
- leadership and technical development academies
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