PBM PDL-PA Hybrid Clinical Pharmacist

Summary

As ​PBM PDL-PA Hybrid 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.

As part of the Gainwell clinical pharmacy practice group, the PDL-PA Hybrid Clinical Pharmacist supports the clinical and operational needs of our Fee-for-Service Medicaid business. This role serves as a collaborative support for the PA, PDL Pharmacists and the Clinical Manager to ensure that all deliverables required for the clinical workstream are delivered on time. This role will also be assigned special projects to manage from end to end.

Your role in our mission

· Manage PDL formularies and criteria for the purposes of adjudication and publishing of prescription drug lists and websites in line with the decisions from the P&T Committee and DUR Board.

· Analyze cost comparisons using pricing methodologies implemented by the State, Federal Medicaid rebates, and State supplemental rebate contract offers to present a comprehensive net cost analysis and make recommendations for agents to be placed on the PDL in conjunction with clinical review of drugs and drug classes.

· Monitor for new drugs on the weekly drug file and apply appropriate drug statuses to PDL formularies.

· Be able to create and manage various PDL lists for different benefit plans, State programs, and lines of business. Responsible for coordinating with each Medicaid account pharmacy team regarding their PDL management needs

· Research and explain clinical and business aspects of drugs and drug strategies to internal business partners. Participate in internal meetings to support and present relevant information as needed. Provide subject matter expertise to troubleshoot PDL formulary related matters.

· Function as the liaison between many Gainwell pharmacy groups to ensure end to end PDL formulary management and prior authorization implementation.

· Contribute and participate in clinical and/or financial committee meetings that manage drug review. Performs drug and class reviews as needed. Creates strategy recommendations regarding drugs, classes, and utilization management edits/criteria.

· Stay informed of upcoming changes in the drug market including Brand patent expirations, generic and bioequivalent releases, new drug therapies, and any other changes in the industry that affect State drug expenditures.

· Clinical evaluation of medication therapy.

· Review Prior Authorization request from medical professions using the PDL Criteria.

· Peer to Peer discussions with medical providers to discuss Prior Authorization reviews.

· Consultations/Interventions: work with Gainwell staff in contacting prescribers needing consultation to provide clinical information on prescribing practices that have been

identified as outliers. Reviews prior authorizations data and determine opportunities for interventions.

· Intervention Refinements: Collaborates on the refinement of consultation scripting; solicits and utilizes input from those contacted toward scripting improvements.

· Operations: Contributes to the success of the Clinical Call Centers and Prior Authorization department by assisting with the implementation and management of both written and verbal communications to members and physicians Is available for consultation on pharmacy-related questions and issues for others within the organization.

· Quality Improvement: 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.

· Medical/Clinical: 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, Clinical Pharmacist, and Clinical Specialty Pharmacist to provide pharmacy expertise.

What we're looking for

· PharmD or B.S. in Pharmacy with relevant Specialty background

· Registered Pharmacist with respective State Licensure (Texas)

· 10+ years' experience in clinical pharmacy

· Strong verbal and written communications skills.

· Highly skilled with Microsoft office products and ability to quickly learn proprietary systems.

What you should expect in this role

• Opportunities to travel through your work (0-10%)

• · Work from Home; reliable high-speed internet connectivity is required

  · Employees working-from-home may be asked to report to the office, at times, to support work efforts.