Pharmacist, Principal

About the role

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.

Responsibilities

• Prior Authorization Criteria Development: Evaluate drug and drug class reviews based on sound evidence-based research and processes widely accepted by the medical profession. Ensure evidence summaries inform the recommendations for management of the preferred drug list (PDL) and clinical prior authorization (PA) criteria. Use appropriate methods that support the principles of high-quality evidence-based medicine. Develop clinical PA criteria recommendations and documents to present to P&T and/or DUR Board. Provide a thorough review of the clinical and pricing data to assist the P&T Committee or DUR Board in reviewing the Gainwell clinical criteria and PDL recommendations to make coverage and PDL placement decisions. Discuss with practicing physicians (and other prescribers) to consult on prescribing of specialty medications including clinical evaluation of specialty trends and impacts.
• Retro DUR Initiatives: Regularly reviews and monitors prescription claims data and prescribing practices identified as outliers by internal and/or external analysis of pharmacy claims data to develop relevant Retrospective DUR initiatives. Present initiatives to the P&T or DUR Board including methods, interventions, communication, and outcomes.
• Consultations/Interventions: Work with Gainwell staff to contact prescribers needing consultation to provide coaching on prescribing practices that have been identified as outliers. Review prior authorizations data and determine opportunities for interventions. Intervention Refinements: Collaborate on the refinement of consultation scripting; solicit and utilize input from those contacted toward scripting improvements.
• Operations: Contribute to the success of the operations of the pharmacy program by assisting with the implementation and management of both written and verbal communications to physicians and prescribers and maintenance of the edits and data elements that support the edits. Available for consultation on pharmacy-related questions and issues for others within the organization. Update and maintain clinical program and outreach program as needed.
• Quality Improvement: Contribute to program improvements by using continuous quality improvement processes, by being proactive in identifying improvement opportunities and by contributing ongoing consultation and collaboration with product leaders.
• Medical/Clinical: Uphold clinical integrity of pharmaceutical solutions by staying up to date on medication information, contributing to the identification of pharmacy program best practices, collaborating with Medical Directors, Medical Dept, and Clinical Dept and providing pharmacy expertise within the organization. Contribute creative solutions to improve operational efficiency and effectiveness of pharmacy team. Coordinate with operations, clinical, medical, reporting, and other internal departments as needed.

Requirements and Experience

• Experience in the coordination of and collaboration of work teams preferred.
• Registered Pharmacist with respective State Licensure (PharmD preferred) or Bachelor of Pharmacy degree.
• Minimum 5 years’ experience in clinical pharmacy or PBM.
• Knowledge of Medicaid at the state and/or federal level.
• Knowledge of pharmacy-related aspects of Medicaid.
• Experience with P&T Committee and DUR Board participation.

Pay

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.