PBM Sr Clinical Manager, Preferred Drug List

Jobs via Dice; Austin (TX); Remote; USD 113,000 - 163,000; Full time

Job summary

A healthcare solutions company is seeking a PBM Senior Clinical Manager in Austin, TX, to enhance the operational and clinical activities associated with Preferred Drug Lists. This mid-senior level role requires strong leadership, operational management skills, and a PharmD degree, offering a competitive salary and benefits.

Benefits

Generous flexible vacation policy

401(k) employer match

Comprehensive health benefits

Educational assistance

Qualifications

• 5+ years of experience in pharmacy benefit or managed care.
• Proven ability to lead and manage a team of clinicians.
• Knowledge of healthcare regulations related to Medicaid.

Responsibilities

• Oversee clinical and operational PDL activities.
• Create and standardize policies and procedures.
• Interact with Pharmacy and Therapeutics Committee members.

Skills

Leadership Experience

Excellent communication skills

Clinical expertise

Operational management

Policy standardization

Stakeholder interaction

Education

PharmD

Job description

PBM Sr Clinical Manager, Preferred Drug List

2 days ago Be among the first 25 applicants

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

As part of the Gainwell clinical pharmacy practice group, the PDL Senior Clinical Manager oversees and streamlines the clinical and operational PDL activities of all of our PDL Clients in the Medicaid Fee for Service Line of Business. This role creates standardized clinical and operational processes for the PDL Clinical Account Managers to follow and be measured by. In addition, the PBM Sr Clinical Manager will be responsible for the clinical and operational activities of one PDL Account. This position will manage a team of clinicians and ensure that adequate training and cross-training is completed. The position will train and mentor new PDL Clinical Account Managers and oversee their performance and growth. The PDL development and maintenance activities include monitoring new drugs, assisting in clinical drug class reviews, and analyzing cost comparisons to develop and maintain Medicaid PDLs. Additional activities include developing PDL related prior authorization criteria, monitoring Client utilization and financial trends and identifying areas for improvement. They will also work with the system teams in implementing, updating, and maintaining PDL information in the Pharmacy Services Module. Operationalization efforts include the correct coding of the weekly PDL and associated formulary files.

Your role in our mission

Primary point of contact for specific Clients for all aspects of the Preferred Drug List maintenance and development

Excellent public speaking abilities.

Ability to present PDL Clinical Information to the Client and at public Pharmacy and Therapeutics Committee meetings in a concise manner

Responsible for creation and standardization of policies and procedures for Operational, Clinical and Reporting PDL activities and training all PDL Clinical Account Managers.

Management of PDL Clinical Account Team Members

Working closely with the PDL and Pricing teams on activities.

Interfacing with Pharmaceutical Managers, Prescribers and Providers on questions related to the PDL

Manage PDL and criteria for the purposes of adjudication and publishing of prescription drug lists and websites in line with the decisions from the P&T Committee and DUR Board.

Monitor for new drugs, new generics, pricing changes and drug shortages on a weekly basis and coding the correct drug statuses to the PDL

Function as the liaison between many internal and external pharmacy stakeholders to ensure end to end PDL formulary management and prior authorization implementation.

Contribute and participate in clinical and/or financial committee meetings that manage drug review. Performs drug and class reviews as needed. Creates strategy recommendations regarding drugs, classes, and utilization management edits/criteria.

Stay informed of upcoming changes in the drug market including Brand patent expirations, generic and bioequivalent releases, new drug therapies, and any other changes in the industry that affect State drug expenditures.

Participating in proposal response and associated presentations

What we're looking for

Demonstrated Leadership Experience And Abilities.

Proven experience managing formularies from a clinical, operational and financial perspective

Proven Ability to interact with multiple different internal and external stakeholders

Proven ability to create and standardize policies and procedures that can be utilized by team members to improve efficiency, streamline activities and promote best practices

Proven ability to lead and manage a team of clinicians

PharmD or commensurate experience.

5+ years of experience in pharmacy benefit or managed care experience

Experience working in Medicaid, healthcare technology, and/or pharmacy analytics is required.

Deep clinical and operational expertise

A strategic mindset with a passion for innovation and development of a rapidly growing line of business

Proven understanding of relevant healthcare regulations (HIPAA, CMS guidelines and best practices) - preferably as related to Medicaid Fee for Service

Excellent verbal and written communication skills.

Ability to abide by Gainwell policies.

Ability to maintain attendance to support required quality and quantity of work.

Maintain confidentiality and comply with Health Insurance Portability and Accountability Act (HIPAA).

Ability to establish and maintain positive and effective work relationships with coworkers, clients, members, providers, and customers.

Ability to develop, organize, and maintain project plans and agendas.

Excellent writing skills, ability to develop presentations, brief proposals, protocols, and review guideline documents.

What you should expect in this role

This position is remote.

Work Hours: Eastern Time Zone

Supports Gainwell Pharmacy COE

The pay range for this position is $113,900.00 - $162,700.00 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.

Seniority level

• Seniority level

  Mid-Senior level

Employment type

• Employment type

  Full-time

Job function

• Job function

  Health Care Provider

• Industries

  Software Development

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