Summary

The Clinical Pharmacist facilitates efforts in the development of pharmacy solutions programs including PA criteria development, PDL management, coordination of Pharmacy and Therapeutic Committee (P&T) and DUR Board meetings. Supports Prospective and Retrospective drug utilization review (DUR) efforts by reviewing physician prescribing patterns, consulting with physicians regarding these patterns using evidence-based best practices, working closely with internal staff in the refinement of the pharmacy management solutions programs, 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
• 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 P&T and/or DUR Board.
• Providing 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.
• Discussions 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 with contacting prescribers needing consultation to provide coaching on prescribing practices that have been identified as outliers. Reviews prior authorizations data and determine opportunities for interventions.
• Intervention Refinements: Collaborates on the refinement of consultation scripting; solicits and utilizes input from those contacted toward scripting improvements.
• Operations: Contributes 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. Is available for consultation on pharmacy-related questions and issues for others within the organization. Updates and maintains clinical program and outreach program 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 product leaders.
• 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, collaborating with Medical Directors, Medical Dept, and Clinical Dept and provides pharmacy expertise within the organization.
• Contributes creative solutions to improve operational efficiency and effectiveness of pharmacy team.
• Coordinates with operations, clinical, medical, reporting, and other internal departments as needed.

What we're looking for
• 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
• Experience in the coordination of and collaboration of work teams preferred.
• 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

What you should expect in this role
• Ability to communicate succinctly and accurately in both written and verbal English.
• Ability to perform clinical reviews using relevant compendia and clinical trial data.
• Managed care pharmaceutical service experience a plus.
• Strong research and implementation skills in practical settings.
• Analytical skills which can translate into practical and pragmatic recommendations.
• Strong team orientation with respect for all members.
• People skills are essential that allow for the successful consultation and collaboration with internal and external stakeholders who do not directly report to this job
• Excellent organizational, written, and oral communication skills
• Maintain confidentiality and comply with Health Insurance Portability and Accountability Act (HIPAA)
• Highly skilled with Microsoft office products and ability to quickly learn proprietary systems.
• Proficient with work organization and problem resolution skills.

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.