Clinical Technical Lead Pharmacist

Job Description

The Clinical/Technical Lead Pharmacist is responsible for analyzing and configuring pharmacy drug benefits and DUR parameters per state and Federal Medicaid pharmacy policy and requirements; providing clinical and technical support for policy and program development; acting as a resource to and a liaison for Gainwell’s technical support staff and management, Gainwell’s clinical and technical call center staff, and the state Medicaid pharmacy customers, providers, and members.

Job Description

• Drug benefit configuration. This includes implementing and updating drug benefits, prior authorization requirements, and limitations as directed by customer policy and requirements; Preferred Drug List (PDL) criteria; and state P&T Committee and DUR Board criteria.
• Regular review of clinical updates from an applicable national drug information database (e.g. FDB/First Databank) and configuration of Drug Utilization Review (DUR) parameters. 
• Updating pharmacy drug pricing, per state customer policy and requirements.
• Supporting clinical programs for the Pharmacy POS (Point of Sale) program, such as criteria development for automatic prior authorization and ePrescribing. 
• Providing direction to the Pharmacy POS helpdesk regarding POS inquiries.

Required Qualifications

• A willingness and ability to learn internal systems/processes/programs, as needed.
• Strong math skills.
• Comprehensive understanding of medication names and medical terminology.
• A Pharmacy BS/PharmD degree from an accredited college or university and an unrestricted state pharmacist license.
• A total of five (5) years of demonstrated management experience in a retail pharmacy setting that includes directly supervising staff, and knowledge of outpatient drug dispensing and billing procedures.

• Preference will be given for additional experience in health care benefits management, including administration of clinical pharmacy benefits and related services; operational experience with state pharmaceutical assistance programs or other publicly financed health programs such as Medicaid that includes administration and payment of pharmacy claims.

Working Environment

• Remote