Clinical Pharmacist Advisor- Remote
About The Position
It takes great medical minds to create powerful solutions that solve some of healthcare’s most complex challenges. Join us and put your expertise to work in ways you never imagined possible. We know you’ve honed your career in a fast-moving medical environment. While Gainwell operates with a sense of urgency, you’ll have the opportunity to work more flexible hours. And working at Gainwell carries its rewards. You’ll have an incredible opportunity to grow your career in a company that values work-life balance, continuous learning, and career development. Summary The account Pharmacist will work directly with the account Pharmacy Manager and the state Pharmacy Program Director to operate the Medicaid prescription drug program within state budget and according to legislative requirements and laws.
Requirements
- Registered Pharmacist with respective State Licensure
- PharmD (preferred) or Bachelor of Pharmacy degree
- At least 5 years of experience working in a pharmacy setting or pharmacy benefit management system.
- Knowledge of Medicaid at the state and/or federal level.
- Knowledge of pharmacy-related aspects of Medicaid.
- Working knowledge of HIPAA regulations and requirements.
Responsibilities
- Conduct clinical evaluations of medication therapy and review prior authorization requests using PDL criteria
- Facilitate peer-to-peer discussions with providers regarding prior authorization decisions
- Collaborate with prescribers and internal teams on clinical consultations and targeted interventions
- Support call center operations by providing clinical guidance and assisting with provider/member communications
- Serve as a subject matter expert for pharmacy-related questions across the organization
- Contribute to quality improvement initiatives and program enhancements
- Maintain clinical expertise and collaborate with cross-functional teams on pharmacy best practices
- Provide input on drug utilization reviews and formulary management
- Support Medicaid Drug Rebate Program operations and assist with state pharmacy audits
- Deliver training to pharmacy providers and contribute to reporting and administrative activities
Benefits
- flexible vacation policy
- 401(k) employer match
- comprehensive health benefits
- educational assistance
- leadership and technical development academies
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What This Job Offers
Job Type
Full-time
Career Level
Senior
