Preferred Drug List (PDL) Pharmacist

Gainwell Technologies LLC

15d•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. SummaryAs part of the Gainwell Pricing and Contracting team, the Preferred Drug List (PDL) Pharmacist supports the clinical, operational and financial PDL needs of the Delaware (DE) Medicaid Fee-for-Service line of business. This role manages the implementation, maintenance and expansion of the PDL and ensures that adjudication and related communications reflect the latest changes. The primary responsibility is the development and maintenance of a clinically appropriate and fiscally responsible PDL. Fulfilling this objective entails the following activities: monitoring drug file-related changes such as new drugs, new generics, discontinuations and their impact; developing PDL-related prior authorization criteria; identifying needed therapeutic class reviews (TCRs) and assisting with their creation and update; analyzing net cost comparisons; and monitoring Client utilization and market share trends. Additional tasks include efficiently operationalizing the program; identifying areas for improvement; and working cross-functionally to implement, update, and maintain PDL-related information in the Pharmacy Services Module.

Requirements

Excellent public speaking abilities
Proven experience managing formularies from clinical, operational and financial perspectives
Strong personal computer and business solutions software skills
Proven ability to interact with varied internal and external stakeholders
Proven ability to interface with and manage Account and Client relationships
PharmD or commensurate experience
3+ years of experience in pharmacy benefits management or managed care
Experience working in Medicaid, healthcare technology, and/or pharmacy analytics is required
Deep clinical and operational expertise
Excellent verbal and written communication skills
Ability to abide by Gainwell policies
Ability to maintain attendance to support required quality and quantity of work
Maintain confidentiality and comply with Health Insurance Portability and Accountability Act (HIPAA).
Ability to establish and maintain positive and effective work relationships with coworkers, clients, members, providers, and customers
Ability to develop, organize, and maintain project plans and agendas

Responsibilities

Act as primary point of contact for the State of DE for PDL management, development, and transformation
Provide PDL subject matter expertise and troubleshoot PDL-related issues
Lead weekly client meetings reviewing clinical, operational, and financial PDL impacts
Monitor drug market changes affecting the PDL, including new drugs/generics, pricing, MDRP updates, and shortages
Manage prior authorization criteria and PDL drug/status coding
Prepare and maintain PDL publications and meeting materials
Participate in and support clinical, financial, and P&T Committee drug reviews
Present complex clinical information clearly to clients and stakeholders
Develop strategic recommendations for drugs, therapeutic classes, and utilization management
Serve as liaison between internal teams and external pharmacy stakeholders
Analyze clinical and net cost data (including rebates) to support PDL decisions
Support PDL-related financial programs and maintain desk-level procedures
Use OOTB technology to support efficient PDL operations