Summary
The account Pharmacist will work directly with the account Pharmacy Manager and the state Pharmacy Program Director to operate the Medicaid prescription drug program within state budget and according to legislative requirements and laws.
Your role in our mission
• Conduct clinical evaluations of medication therapy and review prior authorization requests using PDL criteria
• Facilitate peer-to-peer discussions with providers regarding prior authorization decisions
• Collaborate with prescribers and internal teams on clinical consultations and targeted interventions
• Support call center operations by providing clinical guidance and assisting with provider/member communicationsServe as a subject matter expert for pharmacy-related questions across the organization
• Contribute to quality improvement initiatives and program enhancements
• Maintain clinical expertise and collaborate with cross-functional teams on pharmacy best practices
• Provide input on drug utilization reviews and formulary managementSupport Medicaid Drug Rebate Program operations and assist with state pharmacy audits
• Deliver training to pharmacy providers and contribute to reporting and administrative activities
What we're looking for
• Registered Pharmacist with respective State Licensure
• PharmD (preferred) or Bachelor of Pharmacy degree
• At least 5 years of experience working in a pharmacy setting or pharmacy benefit management system.
• Knowledge of Medicaid at the state and/or federal level.
• Knowledge of pharmacy-related aspects of Medicaid.
• Working knowledge of HIPAA regulations and requirements.
What you should expect in this role
• Remote opportunity within the United States
• Travel: 0-10%
This is a pipeline requisition, and applications will be accepted on an ongoing basis.
The pay range for this position is $115,000.00 - $150,000.00 per year, however, the base pay offered may vary depending on geographic region, internal equity, job-related knowledge, skills, and experience among other factors. Put your passion to work at Gainwell. You'll have the opportunity to grow your career in a company that values work flexibility, learning, and career development. All salaried, full-time candidates are eligible for our generous, flexible vacation policy, a 401(k) employer match, comprehensive health benefits, and educational assistance. We also have a variety of leadership and technical development academies to help build your skills and capabilities.
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