Clinical Pharmacist

Summary

As a Clinical Pharmacist at Gainwell, you can contribute your skills as we harness the power of technology to help our clients improve the health and well-being of the members they serve — a community’s most vulnerable.

Connect your passion with purpose, teaming with people who thrive on finding innovative solutions to some of healthcare’s biggest challenges. Here are the details on this position.

Your role in our mission

•    Contributes to the success of the operations of the pharmacy program by assisting with the implementation and management of both written and verbal communications to physicians and prescribers and

maintenance of the edits and data elements that support the edits. Is available for consultation on pharmacy-related questions and issues for others within the organization (e.g. health coaches, care

managers, etc.). Updates and maintains program engine, coding, consultation sheets, and outreach program as needed.

•    Ensuring evidence summaries inform the recommendations for management of the preferred drug list (PDL) and clinical prior authorization (PA) criteria. Using appropriate methods that support the

principles of high-quality evidence-based medicine.  

•    Regularly reviews and monitors prescription claims data and prescribing practices identified as outliers by internal and/or external analysis of pharmacy claims data to develop relevant interventions.  

•    Evaluate drug and drug class reviews based on sound evidence-based research and processes widely accepted by the medical profession.

•    Develop clinical PA criteria recommendations and documents to present to P&T and/or DUR Board.

•    Present initiatives to the P&T or DUR Board including methods, interventions, communication, and outcomes.

•    Providing a thorough review of the clinical and pricing data to assist the P&T Committee or DUR Board in reviewing the Gainwell clinical criteria and PDL recommendations in order to make coverage and

PDL placement decisions.

•    Contacts physicians and prescribers identified as needing consultation to provide coaching on prescribing practices that have been identified as outliers.  

•    Review the prior authorization process and identify opportunities for interventions.

•    Documents content of and results of consultations as defined in operations procedures; maintains records as required.

•    Collaborates on the refinement of consultation scripting; solicits and utilizes input from those contacted toward scripting improvements.

•    Contributes to program improvements by using continuous quality improvement processes, by being proactive in identifying improvement opportunities and, by contributing on-going consultation and

collaboration with product leaders.

•    Upholds clinical integrity of pharmaceutical solutions by staying up to date on medication information, contributing to the identification of pharmacy program best practices, collaborating with Medical

Directors, Medical Dept, and Clinical Dept and, providing pharmacy expertise within the organization.

•    Contribute solutions to improve operational efficiency and effectiveness of the pharmacy team.
 

What we're looking for

•    Management experience in the coordination of and collaboration of work teams preferred.

•    5 years' experience in clinical pharmacy

•    Ability to perform clinical reviews using relevant compendia and clinical trial data

•    Managed care pharmaceutical service experience plus experience with coaching physicians and prescribers on medication issues, especially on specialty medications.

•    Knowledge of current research related to specialty medications

•    Strong research and implementation skills in practical settings.

•    Analytical skills which can translate into practical and pragmatic recommendations.

•    Strong team orientation with respect for all members. 

•    Strong verbal and written communications skills.

•    People skills are essential that allow for the successful consultation with physicians, prescribers and pharmacists and for successful collaboration with company employees and external vendors who do

not directly report to this job.

•    Must be comfortable with using computers and the internet; basic skills with Microsoft office products and ability to quickly learn proprietary systems.
 

What you should expect in this role

•    Fully remote opportunity

•    Monday-Friday, standard business hours