Clinical Pharmacist

🕒 July 15

🏈 Ohio – Remote

🏈 Ohio – Remote

💵 $135k - $165k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

💊 Pharmacist

🦅 H1B Visa Sponsor

This company has sponsored H1B visas in the past.

Apply Now

Find Similar Remote Jobs

Set Up Email Alert For New Jobs

📊 Check your resume score for this job

Improve your chances of getting an interview by checking your resume score before you apply.

Upload Resume

Gainwell Technologies

WebsiteLinkedInAll Job Openings

10,000+ employees

⚕️ Healthcare Insurance

💰 Grant on 2023-06

Healthcare Insurance • Human Services • Healthcare

Gainwell Technologies is the nation’s leading provider of digital and cloud-enabled solutions across the human services and public health ecosystem. With a mission-driven approach, Gainwell serves clients in all 50 U. S. states, focusing on improving health outcomes and delivering intuitive, human-centered experiences. Their comprehensive suite of solutions includes Medicaid Enterprise modernization, data analytics, provider services, and pharmacy solutions, all designed to advance the future of healthcare and enhance community well-being.

📋 Description

• Evaluating prescription claims data, developing and presenting clinically driven recommendations and initiatives • Evaluating utilization management criteria and operational impact • Supporting and maintaining configuration requirements • Researching policy and regulatory drivers, coordinating with operations, claims, network, reporting, medical management, population health, and other internal stakeholders • Analyzing clinical, utilization, prescribing, claims, and pricing data to identify opportunities that improve medication use, quality outcomes, cost effectiveness, medication adherence, preventive care, health equity, and population health performance • Developing, implementing, managing, and evaluating utilization management programs and clinical interventions aligned with organizational goals • Reviewing prescribing patterns, prescription claims, and prior authorizations to identify gaps in care, high-risk populations, and opportunities to improve quality and safety • Conducting provider consultations and evidence-based education, building collaborative provider relationships, and partnering with Medical Directors • Leading and collaborating across pharmacy, medical management, quality, care management, analytics, operations, claims, network management, technology, and other teams to implement programs and solve complex clinical and business challenges • Presenting program methodologies, outcomes, and recommendations to governance committees

🎯 Requirements

• Licensed Pharmacist • Minimum of five (5) years of experience in pharmacy benefit management or pharmacy managed care • Detailed knowledge of Medicaid programs at both state and federal levels • Ability to communicate succinctly and accurately in both written and verbal English across diverse audiences • Experience presenting complex clinical findings, recommendations, and program outcomes to senior leaders • Ability to manage multiple projects simultaneously and effectively prioritize competing demands • Experience evaluating healthcare data, clinical outcomes, quality measures, and performance metrics • Demonstrated experience applying population health principles to improve medication use, quality outcomes, and healthcare delivery • Demonstrated leadership experience driving results through influence and collaboration across highly matrixed, cross-functional organizations • Proven success leading cross-functional teams and building partnerships across pharmacy, medical, quality, operations, analytics, provider engagement, care management, and technology functions • Experience with the end-to-end pharmacy claims lifecycle, clinical operations, medication pricing methodologies, NCPDP standards, financial management, managed care regulations, and healthcare quality initiatives • Maintain confidentiality and comply with Health Insurance Portability and Accountability Act (HIPAA) requirements • Strong PC skills with advanced proficiency in Microsoft Office, data analysis, project management, problem-solving, and virtual collaboration platforms (Microsoft Teams, Zoom)

🏖️ Benefits

• Comprehensive health benefits • 401(k) employer match • Flexible vacation policy • Educational assistance • Leadership and technical development academies