Medicaid Clinical Pharmacist

🔥 15 hours ago

🇺🇸 United States – Remote

💵 $113.7k - $162.4k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

💊 Pharmacist

🦅 H1B Visa Sponsor

This company has sponsored H1B visas in the past.

👻 Ghost score 0%

What it means: how likely this posting is sitting open without active hiring.How to read it: 60% or higher means we think this is a ghost. Lower scores are less of a worry.How we score it: age, reposts, open roles vs team size, how fast jobs close, and whether pay is listed.Fine print: an estimate from public data, not a judgment of the company. Real jobs can score high, so treat it as a hint, not a fact.

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

💼 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

• Participate in all aspects of the Connecticut Medicaid program’s clinical services • Report to the Connecticut Medical Assistance Pharmacy Program’s Manager • Evaluate drug and drug class reviews using evidence-based research • Develop clinical prior authorization criteria recommendations and documents for the Connecticut client • Coordinate Preferred Drug List changes based on Pharmacy and Therapeutics Committee recommendations • Provide clinical guidance, mentorship, and support to account-based pharmacy prior authorization pharmacists • Promote consistent application of prior authorization criteria and resolve escalations • Support the state client on fair hearings and escalations • Identify improvement opportunities and contribute to continuous quality improvement • Develop and maintain question sets and rules for Intelligent Prior Authorization during claims adjudication • Provide pharmacy expertise and maintain clinical integrity of pharmaceutical solutions • Improve operational efficiency and effectiveness of the account pharmacy team • Engage development teams with business input and guidance on product enhancements and technical tools • Strengthen collaboration across the pharmacy and drug rebate business • Participate in corporate pharmacy team meetings

🎯 Requirements

• Minimum of five (5) years of experience in pharmacy benefit management • Minimum of three (3) years of experience working with a Medicaid PBM account • Detailed knowledge of Medicaid at the state and federal level • PharmD required • Working knowledge of HIPAA regulations and requirements • Licensed pharmacist required; Connecticut license preferred but not required • Managed-care pharmaceutical service experience • Experience coaching physicians and prescribers on medication issues, especially specialty medications • Ability to communicate succinctly and accurately in written and verbal English • Strong leadership abilities and proactive initiative • Analytical skills for translating information into practical recommendations • Ability to work independently and in a team environment • Ability to work effectively and efficiently under stringent timelines • Excellent organizational, written, and oral communication skills • Ability to maintain confidentiality and comply with HIPAA • Proficient PC abilities and basic knowledge of MS Office • Work organization and problem resolution skills • Proficiency with virtual communication platforms including Microsoft Teams, Skype, and Zoom

🏖️ Benefits

• Flexible hours • Work-life balance • Continuous learning and career development • 100% remote work • Flexible vacation policy • 401(k) employer match • Comprehensive health benefits • Educational assistance • Leadership and technical development academies • Up to 10% travel may be required