Medicaid Clinical Pharmacist

Jobtailor; Deutschland; Remote; EUR 103.000 - 155.000; Vollzeit

Zusammenfassung

Jobtailor is seeking a PharmD-licensed pharmacist with extensive experience in Pharmacy Benefit Management to support Medicaid programs. You will lead clinical PA development, review drug classes, and guide account-based pharmacists while ensuring HIPAA compliance and regulatory alignment.

The role emphasizes leadership, mentorship, and collaboration across teams, with responsibility for policy recommendations, PDL updates, and operational efficiency within a Medicaid PBM context.

Qualifikationen

• PharmD degree required.
• Licensed pharmacist in good standing; Connecticut license preferred but not required.
• Minimum 5 years of experience in pharmacy benefit management.
• Minimum 3 years of experience with Medicaid PBM accounts.
• Detailed knowledge of Medicaid at state and federal level.
• Working knowledge of HIPAA regulations and requirements.

Aufgaben

• Participate in all aspects of 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.

Kenntnisse

Clinical Prior Authorization Develop

Drug Class Review Evaluation

Pharmaceutical Solutions Expertise

Analytical Skills

Operational Efficiency Improvement

Strong Communication Skills

Organizational Skills

Problem Resolution Skills

Team Collaboration

Proactive Initiative

Microsoft Office

Microsoft Teams

Skype

Zoom

Ausbildung

PharmD

Tools

Microsoft Office

Microsoft Teams

Skype

Zoom

Jobbeschreibung

• 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

Core Competencies

Demonstrates expertise in pharmacy benefit management and Medicaid programs, with a strong focus on clinical services, prior authorization criteria, and operational efficiency. Possesses leadership skills to mentor pharmacy teams and effectively communicate with stakeholders.

Highest-signal resume keywords

• Pharmacy Benefit Management Experience
• Medicaid Program Knowledge
• PharmD Degree
• HIPAA Compliance
• Leadership and Mentorship Skills

ATS Optimization Keywords

Hard Skills

• Clinical Prior Authorization Development
• Drug Class Review Evaluation
• Pharmaceutical Solutions Expertise
• Analytical Skills
• Operational Efficiency Improvement

Soft Skills

• Strong Communication Skills
• Organizational Skills
• Problem Resolution Skills
• Team Collaboration
• Proactive Initiative

Certifications & Qualifications

• Licensed Pharmacist
• PharmD

Industry Keywords

• Medicaid
• Managed-Care Pharmaceutical Services
• Pharmacy and Therapeutics Committee
• Prior Authorization Criteria
• Continuous Quality Improvement

Tools & Technologies

• Microsoft Office
• Microsoft Teams
• Skype
• Zoom