PBM Implementation Pharmacist- Remote

Gainwell Technologies LLC•Any city, OH

6d•$113,700 - $162,400•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 PBM Implementation Pharmacist reports to the Director of Clinical Operations and leads the clinical setup of new Pharmacy Benefit Management (PBM) accounts from both system and functional perspectives. This role serves as the subject matter expert for pharmacy services, including benefit plan drug coverage, edit configuration, prospective and retrospective drug utilization review (DUR), prior authorization (PA) criteria and rule configuration, and coordination with the implementation practice team to support successful program implementation for customer organizations.

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

Nice To Haves

PBM or managed care pharmaceutical service experience preferred
Understanding of Medispan hierarchies is preferred
Proficient PC abilities (basic knowledge of MS Office applications), work organization, and problem‑resolution skills, including the ability to learn configuration activities in a PBM database and other technical tools
Proficient on multiple virtual communication platforms (Microsoft Teams, Skype, Zoom, etc.)
Ability to communicate succinctly and accurately in both written and verbal English in various group settings
Strong leadership abilities demonstrating proactive initiative
Analytical skills that translate into practical and pragmatic recommendations
Ability to work independently and in a team environment
Ability to work effectively and efficiently under stringent timelines
Excellent organizational, written, and oral communication skills
Ability to maintain confidentiality and comply with the Health Insurance Portability and Accountability Act (HIPAA)

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