Connecticut Medicaid Clinical Pharmacist

Gainwell Technologies; Connecticut; Remote; USD 113,000 - 163,000; Full time

Job summary

Gainwell Technologies is seeking a Clinical Pharmacist to join their Connecticut team. This 100% remote position involves significant responsibilities within the Medicaid program, requiring extensive experience in pharmacy management and a PharmD. Candidates can expect a supportive work culture that promotes growth and flexibility, in addition to a competitive salary range.

Benefits

Flexible vacation policy

401(k) employer match

Comprehensive health benefits

Educational assistance

Leadership and technical development academies

Qualifications

• Minimum of five years of experience in pharmacy benefit management.
• Detailed knowledge of Medicaid at state and federal levels.
• Working knowledge of HIPAA regulations.

Responsibilities

• Participate in all aspects of the Connecticut Medicaid program’s clinical services.
• Evaluate drug reviews based on sound evidence-based research.
• Assist in developing clinical PA criteria.

Skills

Analytical skills

Leadership

Communication skills

Problem resolution

Education

PharmD

Tools

MS Office

Job description

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Location:

Any city, CT, US, 99999

It takes great medical minds to create powerful solutions that solve some of healthcare’s most complex challenges. Join us and put your expertise to work in ways you never imagined possible. We know you’ve honed your career in a fast-moving medical environment. While Gainwell operates with a sense of urgency, you’ll have the opportunity to work more flexible hours. And working at Gainwell carries its rewards. You’ll have an incredible opportunity to grow your career in a company that values work-life balance, continuous learning, and career development.

Summary

The Connecticut clinical pharmacist will report to the Connecticut Medical Assistance Pharmacy Program’s Manager and will be responsible for participating in all aspects of the Connecticut Medicaid program’s clinical services. This position will involve multiple facets of the pharmacy services including Prior Authorization criteria development, coordination of Preferred Drug List (PDL) changes as it relates to the recommendations set forth by the Pharmacy and Therapeutic Committee (P&T), working closely with internal staff in the refinement of the pharmacy management processes and solutions, working with the formulary management team on PDL development providing consultation on pharmacy issues to clinical operations representatives and facilitating the successful implementation of these programs for customer organizations.

Your role in our mission

Essential Job Functions

• Prior Authorization Criteria Development: Evaluate drug and drug class reviews based on sound evidence-based research and processes widely accepted by the medical profession. Ensuring evidence summaries inform the recommendations for management of the preferred drug list (PDL) and clinical prior authorization (PA) criteria. Using appropriate methods that support the principles of high-quality evidence-based medicine. Develop clinical PA criteria recommendations and documents to present to Connecticut Client.
• When needed, assisting the account team in reviewing and processing clinical prior authorizations and interacting with prescribers on denial decisions
• Support the State Client on Fair Hearings and escalations as needed
• Quality Improvement: Contributes to program improvements by using continuous quality improvement processes, by being proactive in identifying improvement opportunities and by contributing on-going consultation and collaboration with account leader.
• Automated prior authorization: assist account in developing and maintaining question sets and rules for Intelligent PA (Auto PA during claims adjudication).
• Medical/Clinical: Upholds clinical integrity of pharmaceutical solutions by staying up to date on medication information, contributing to the identification of pharmacy program best practices, and provides pharmacy expertise within the organization.
• Contributes creative solutions to improve operational efficiency and effectiveness of the account pharmacy team.
• Engage with the development teams to provide business input and guidance on product enhancements and technical tools.
• Encourage and strengthen cohesiveness and team unity across the pharmacy and drug rebate business on all Gainwell accounts.
• Participate in corporate pharmacy team meetings.

What we're looking for

• 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 plus experience with coaching physicians and prescribers on medication issues, especially on specialty medications.
• Ability to communicate succinctly and accurately in both written and verbal English in various group settings from individuals to large groups.
• Strong leadership abilities which demonstrate proactive initiative.
• Analytical skills which can translate into practical and pragmatic 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
• Maintain confidentiality and comply with Health Insurance Portability and Accountability Act (HIPAA)
• Proficient PC abilities (basic knowledge in MS Office), work organization, and problem resolution skills.

What you should expect in this role

This position is 100% remote, up to 10% travel.

The pay range for this position is$113,700.00-$162,400.00 per year, however, the base pay offered may vary depending on geographic region, internal equity, job-related knowledge, skills, and experience among other factors. Put your passion to work at Gainwell. You’ll have the opportunity to grow your career in a company that values work flexibility, learning, and career development. All salaried, full-time candidates are eligible for our generous, flexible vacation policy, a 401(k) employer match, comprehensive health benefits , and educational assistance. We also have a variety of leadership and technical development academies to help build your skills and capabilities.

We believe nothing is impossible when you bring together people who care deeply about making healthcare work better for everyone. Build your career with Gainwell, an industry leader. You’ll be joining a company where collaboration, innovation, and inclusion fuel our growth. Learn more about Gainwell at our company website and visit our Careers site for all available job role openings.

Gainwell Technologies is an Equal Opportunity Employer, where all qualified applicants will receive consideration for employment without regard to race, religion, color, national origin, gender (including pregnancy, childbirth, or related medical condition), age, sexual orientation, status as a protected veteran, status as an individual with a disability, or other applicable legally protected characteristics.