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Clinical Technical Lead Pharmacist

Date:  Jan 10, 2023

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.

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