Principal Clinical Pharmacist

🔥 0 minutes ago

🇺🇸 United States – Remote

💵 $113.7k - $162.4k / year

⏰ Full Time

🔴 Lead

💊 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

• Support prior authorization program builds by translating approved clinical criteria, coverage requirements, client rules, and workflow needs into build requirements • Partner with cross-functional teams to configure PA workflows, clinical logic, renewals, letters, routing, reporting, and operational processes • Create and maintain test scenarios, test cases, validation documentation, and requirements traceability • Participate in QA, unit, integration, UAT, regression, and production testing for PA builds and updates • Validate PA workflows and clinical logic against approved policies, client requirements, regulations, and operational expectations • Identify and document configuration issues, workflow gaps, risks, and clinical inconsistencies; support resolution efforts • Support production readiness by ensuring requirements, testing, documentation, reporting, procedures, and approvals are complete • Maintain PA criteria, drug class reviews, clinical policies, and evidence-based materials • Use claims, PA, utilization, quality, and trend data to support analysis, investigations, and program improvements • Support clinical program operations, including PDL, provider engagement, adherence, safety, specialty pharmacy, quality, and population health initiatives • Provide senior-level clinical and operational guidance to improve quality, compliance, workflows, and program performance • Mentor team members on PA workflows, configuration, testing, clinical rationale, and best practices

🎯 Requirements

• Active pharmacist license in good standing required • PharmD preferred; Bachelor of Pharmacy degree accepted • Preferred: 7 or more years of progressive experience in clinical pharmacy, managed care, PBM, Medicaid pharmacy, prior authorization, pharmacy operations, or related clinical program operations • Hands-on experience supporting prior authorization builds, clinical criteria implementation, pharmacy benefit or PA configuration, workflow setup, operational requirements, or system-enabled clinical programs strongly preferred • Experience participating directly in QA, unit testing, system integration testing, user acceptance testing, regression testing, defect review, production validation, or implementation readiness activities strongly preferred • Experience translating clinical policy, coverage criteria, client requirements, regulatory expectations, and operational workflows into build requirements, configuration inputs, test cases, and validation documentation preferred • Strong knowledge of Medicaid pharmacy programs, managed care pharmacy, PBM operations, state and federal requirements, regulatory expectations, and pharmacy-related Medicaid requirements preferred • Experience supporting P&T Committee activities, DUR Board activities, PDL management, DUR initiatives, academic detailing, population health, clinical quality, provider outreach, or clinical program improvement preferred • Experience working cross-functionally with clinical, operations, configuration, technology, reporting, product, account management, client-facing teams, and leadership stakeholders • Proficiency with Microsoft Office products and ability to quickly learn proprietary systems, workflow tools, reporting platforms, and configuration or testing tools

🏖️ Benefits

• Benefits begin on Day One • Flexible hours • Work-life balance • Continuous learning and career development • Remote work available anywhere within the United States • Generous, flexible vacation policy • 401(k) employer match • Comprehensive health benefits • Educational assistance • Leadership and technical development academies