Clinical Pharmacist

🕒 July 15

🇺🇸 United States – Remote

💵 $135k - $165k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

💊 Pharmacist

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Gainwell Technologies

WebsiteLinkedInAll Job Openings

10,000+ employees

💼 Consulting

📦 Logistics

⚕️ Healthcare Insurance

💰 Grant on 2023-06

Consulting • Logistics • Healthcare Insurance

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

• Analyze clinical, utilization, prescribing, claims, and pricing data to identify opportunities to improve medication use, quality outcomes, cost effectiveness, adherence, preventive care, health equity, and population health performance • Develop, implement, manage, and evaluate utilization management programs, RetroDUR initiatives, clinical interventions, communications, clinical edits, coding, consultation tools, outreach efforts, and other pharmacy strategies • Review prescribing patterns, prescription claims, and prior authorizations to identify care gaps, high-risk populations, outlier practices, and opportunities to improve quality, safety, adherence, and member outcomes • Conduct provider consultations and evidence-based education; build collaborative provider relationships; and partner with Medical Directors and cross-functional stakeholders • Lead and collaborate across pharmacy, medical management, quality, care management, analytics, operations, claims, network management, technology, and other teams • Present program methodologies, interventions, outcomes, and recommendations to governance committees and evaluate impact on quality and clinical objectives • Support regulatory and organizational performance measures • Serve as a pharmacy subject matter expert and strategic advisor • Maintain current knowledge of medications, treatment guidelines, and industry best practices • Drive continuous quality improvement, operational excellence, innovation, and efficiency across pharmacy programs and operations • Perform other duties as assigned

🎯 Requirements

• Licensed Pharmacist • Minimum of five (5) years of experience in pharmacy benefit management or pharmacy managed care • Detailed knowledge of Medicaid programs at state and federal levels • Ability to communicate succinctly and accurately in written and verbal English • Experience presenting complex clinical findings, recommendations, and program outcomes to senior leaders, clients, and governance committees • Ability to manage multiple projects and prioritize competing demands • Experience evaluating healthcare data, clinical outcomes, quality measures, and performance metrics • Experience applying population health principles to improve medication use, quality outcomes, and healthcare delivery • Leadership experience driving results through influence and collaboration across 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 • Ability to maintain confidentiality and comply with HIPAA requirements • Strong PC skills with advanced proficiency in Microsoft Office, data analysis, project management, problem-solving, and virtual collaboration platforms such as Microsoft Teams and Zoom • Ability to travel up to 25%, including occasional overnight travel • Must reside within the United States

🏖️ Benefits

• Flexible hours and work flexibility • Work-life balance • Continuous learning and career development • Generous, flexible vacation policy • 401(k) employer match • Comprehensive health benefits • Educational assistance • Leadership and technical development academies • Travel expense reimbursement (included in Gainwell’s definition of wages and wage rates)