[Remote] PBM Leveraged Clinical Pharmacist- Remote

Note: The job is a remote job and is open to candidates in USA. Gainwell Technologies is a leader in healthcare solutions, seeking a Leveraged Clinical Pharmacist to support their Pharmacy Benefit Management (PBM) services. This role involves developing and executing pharmacy programs, collaborating on drug strategies, and supporting clinical services to enhance operational efficiency and client satisfaction.ResponsibilitiesTherapeutic Class Review (TCR) Development — Conduct evidence‑based evaluations of drugs and drug classes using accepted clinical methodologies. Develop and maintain Gainwell TCRs to support recommendations for Preferred Drug List (PDL) management and clinical prior authorization (PA) criteriaPrior Authorization and Clinical Program Development — Apply evidence‑based medicine principles to develop clinical PA recommendations and supporting documentation for presentation to the P&T Committee and/or DUR Board. Contribute to the development and maintenance of question sets and rules configured within the PA Engine and electronic prior authorization (ePA) systemPreferred Drug List (PDL) Support — Review clinical and pricing data to support the Gainwell clinical PDL team in preparation for state P&T Committee and DUR Board meetingsRetrospective DUR Initiatives — Review and monitor prescription claims data and prescribing patterns identified as outliers through internal and external analyses to develop relevant retrospective DUR initiativesClinical Services Publications — Contribute to the development of Clinical Services publications produced on a weekly, monthly, quarterly, and as‑needed basisProgram Improvement and Clinical Support — Support continuous quality improvement by identifying enhancement opportunities, developing solutions to improve operational efficiency, maintaining the clinical integrity of pharmaceutical solutions, and contributing to pharmacy best practices across the organizationClient, Product, and Business Support — Provide support to client accounts during implementation, maintenance, and ongoing operations. Serve as a subject matter expert for pharmacy product development, sales pursuits, request for proposal (RFP) responses, and due‑diligence initiatives, and partner with development teams to provide business guidance on product enhancements and technical toolsCross‑Functional Collaboration — Promote collaboration and alignment across the pharmacy business in support of Gainwell accountsSkillsDoctor of Pharmacy (PharmD) degree requiredActive Pharmacist license is requiredMinimum of 5 years of experience in pharmacy benefit managementMinimum of 3 years of experience supporting a Medicaid PBM accountDemonstrated knowledge of Medicaid requirements at the state and federal levelsWorking knowledge of HIPAA regulations and related compliance requirementsProficient in PowerPoint and comfortable delivering presentations both within the organization and to external audiencesStrong written and verbal communication skills, including the ability to communicate clearly and accurately in individual and group settingsDemonstrated leadership capability and a proactive, solution-oriented approachStrong analytical skills and the ability to translate findings into practical recommendationsAbility to work independently and collaboratively in a team environmentAbility to manage competing priorities and perform effectively within tight timelinesAbility to maintain confidentiality and comply with HIPAA requirementsProficiency in Microsoft Office, virtual communication platforms, and general organizational and problem-solving skillsBenefitsGenerous, flexible vacation policyA 401(k) employer matchComprehensive health benefitsEducational assistanceA variety of leadership and technical development academies to help build your skills and capabilitiesCompany OverviewGainwell Technologies is a provider of Information Technology & Services. It is a sub-organization of Veritas Capital. It was founded in 2009, and is headquartered in Irving, Texas, USA, with a workforce of 10001+ employees. Its website is https://www.gainwelltechnologies.com/.