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Clinical Technical Lead Pharmacist
Date:
Jan 10, 2023
Location:
Charleston, WV, US, 25302-3932
Req ID:
11948
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.