Principal Medicaid Pharmacy Strategist, PDL, Pricing & Contracting

Job not on LinkedIn

🔥 10 minutes ago

🌽 Illinois – Remote

🌽 Illinois – 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 Medicaid Preferred Drug List (PDL) strategy through analysis of drug products, clinical criteria, utilization, pricing, and rebate opportunities • Conduct financial analyses using drug pricing, utilization, and Medicaid rebate data to support formulary and coverage recommendations • Evaluate clinical criteria, prior authorizations, and pharmacy benefit requirements to optimize access, cost, and rebate outcomes • Analyze utilization, expenditures, pricing trends, and supplemental rebate offers to develop client recommendations • Build reports, forecasts, and analytical models using advanced Excel and large datasets • Present findings to clients and committees, translating complex clinical and financial data into actionable recommendations • Collaborate with cross-functional teams to implement PDL, rebate, and pharmacy program strategies • Monitor market developments, validate program data, and maintain accurate analytical documentation

🎯 Requirements

• Licensed Pharmacist (RPh or PharmD) in the U.S. • 5+ years of pharmacy experience, including Medicaid pharmacy, managed care, PBM operations, formulary management, or related areas • Strong knowledge of Medicaid pharmacy programs, including PDLs, utilization management, prior authorization, claims adjudication, and pharmacy benefit operations • Experience with drug pricing, Medicaid rebates, supplemental rebates, pharmaceutical contracting, and financial analysis • Experience developing or evaluating formularies, PDLs, prior authorization, and utilization management criteria • Advanced Microsoft Excel skills, including analysis of large datasets and financial modeling • Ability to translate clinical, pricing, utilization, and rebate data into sound pharmacy benefit recommendations • Preferred: Experience supporting state Medicaid PDL programs, Medicaid supplemental rebate programs, rebate pools, or multi-state contracting initiatives • Strong analytical and problem-solving skills with experience identifying and reconciling data discrepancies across multiple sources • U.S. work location required

🏖️ Benefits

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