Preferred Drug List (PDL) Pharmacist

Gainwell Technologies LLC•Any city, OH

6d•$113,700 - $162,400•Remote

About The Position

As a Preferred Drug List (PDL) Pharmacist supporting Gainwell’s Pricing and Contracting team, this role supports the clinical, operational, and financial PDL needs of the Delaware Medicaid Fee-for-Service line of business. The pharmacist oversees development, implementation, maintenance, and expansion of a clinically appropriate and fiscally responsible PDL, ensuring adjudication and related communications reflect current program requirements. The role monitors drug-market changes, develops prior authorization criteria, supports therapeutic class reviews, analyzes net cost and utilization trends, and collaborates across teams to manage PDL-related information and programs. It serves as the State of Delaware’s primary point of contact and subject matter expert for PDL maintenance, development, expansion, and transformation, including clinical, operational, and financial impacts. The position is remote, works during Eastern Time Zone hours, and supports the Gainwell Pharmacy Center of Excellence (COE). The pharmacist must maintain confidentiality and comply with HIPAA and applicable Gainwell policies, as well as maintain regular attendance and effective working relationships with coworkers, clients, members, providers, and customers.

Requirements

Active, unrestricted Registered Pharmacist license in any state.
PharmD or equivalent education and experience.
At least three years of pharmacy benefits management or managed care experience.
Knowledge of Medicaid at the state and/or federal level, including experience working in Medicaid, healthcare technology, and/or pharmacy analytics.
Experience supporting Pharmacy & Therapeutics Committee and Drug Utilization Review Board activities.
Experience managing formularies from clinical, operational, and financial perspectives.
Strong analytical, client relationship, communication, and technology skills.
Ability to translate complex clinical and business information into actionable recommendations.

Responsibilities

Serve as the primary point of contact and subject matter expert for the State of Delaware on PDL maintenance, development, expansion, and transformation, including clinical, operational, and financial impacts.
Oversee PDL operations and monitor drug launches, generics, biosimilars, discontinuations, pricing, shortages, patent expirations, Medicaid Drug Rebate Program changes, and other relevant market developments.
Develop and maintain prior authorization criteria, drug coding and status files, therapeutic class reviews, publications, and Pharmacy & Therapeutics Committee materials and deliverables.
Analyze clinical evidence, utilization, market share, net cost, and rebate considerations to develop strategic recommendations for drug coverage, therapeutic classes, and utilization management.
Present clinical and financial recommendations to clients and Pharmacy & Therapeutics Committee stakeholders, coordinating across clinical, account, pharmacy, and other internal and external teams.
Drive continuous improvement of PDL operations and financial programs, including value-based and volume-based agreements, Brand over Generic, and preferred diabetic supply programs, using processes and technology to improve efficiency.
Maintain confidentiality and comply with HIPAA and applicable Gainwell policies.
Maintain regular attendance and effective working relationships with coworkers, clients, members, providers, and customers.