PBM Implementation Pharmacist

🕒 June 18

🔔 Pennsylvania – Remote

🔔 Pennsylvania – Remote

💵 $113.7k - $162.4k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

💊 Pharmacist

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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

• Serve as the primary clinical SME on pharmacy implementations • Lead clinical and drug reference domains on pharmacy design, development, and implementations (DDIs) • Be a primary point of contact with the state client pharmacy team during the DDI and hypercare phases • Ensure benefit plan drug coverages are configured accurately to state client specifications and requirements • Validate successful and accurate conversion of pharmacy data from other vendors and stakeholders • Ensure all point‑of‑sale (POS) claims processing edits, pricing, return messaging, and configuration meet the business requirements of the client • Work with engineering and pharmacy business analyst teams to configure automated PA rule sets and electronic prior authorization (EPA) question sets, including testing scenarios and validation with the client • Track and document progress of clinical domain activities against requirements and timelines, and provide status reports to senior leaders • Identify risks or issues, ensure they are documented and tracked, and work with appropriate stakeholders to resolve them • Maintain a clear understanding of the operational readiness, certification, and delivery status of all Gainwell pharmacy implementations • Provide subject matter expertise for pharmacy and drug rebate product development, sales pursuits, RFP responses, and DDIs • Encourage and strengthen cohesiveness and team unity across the pharmacy business and stakeholders on all Gainwell pharmacy implementations • Participate in corporate pharmacy team meetings

🎯 Requirements

• Active pharmacist license is required • 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 • Experience and knowledge of NCPDP standards and point-of-sale (POS) pharmacy claim processing is required • Experience and knowledge of First Databank (FDB) drug hierarchies, drug reference files, and prospective DUR parameters is required; understanding of Medispan hierarchies is preferred

🏖️ Benefits

• comprehensive health benefits • flexible vacation policy • 401(k) employer match • educational assistance • leadership and technical development academies