SummaryThe 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. The candidate will also provide clinical leadership and indirect oversight to account-based pharmacy prior authorization pharmacists, supporting consistency in clinical decision-making, interpretation of PA criteria, escalation management, and alignment with client expectations.
Your role in our mission- 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.
- Provide clinical guidance, mentorship, and support to account-based pharmacy prior authorization pharmacists to promote consistent application of PA criteria, high-quality clinical reviews, timely escalation resolution, and alignment with Connecticut Medicaid program expectations.
- 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.
- Proficient on multiple virtual communication platforms (Microsoft Teams, Skype, Zoom, etc.)
What you should expect in this role- 100% Remote (United States)
- Up to 10% travel may be required
Applications will be accepted through October 2, 2026.
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.
