SummaryThe Principal Clinical Pharmacist supports the successful build, configuration, testing, and ongoing quality assurance of prior authorization (PA) programs and related pharmacy clinical workflows. This role is primarily responsible for translating approved clinical policies, coverage criteria, client requirements, and operational needs into accurate PA build requirements, configuration inputs, test scenarios, validation activities, and release-ready solutions. This is a hands-on role that requires direct involvement in PA build requirements, configuration validation, QA testing, defect resolution, and production readiness activities. As a senior clinical subject matter expert, the position partners closely with clinical, operations, technology, product, reporting, and client-facing teams to ensure PA workflows are configured correctly, tested thoroughly, and ready for compliant operational use. The role also contributes to broader clinical program operations over time, including drug utilization review (DUR), preferred drug list (PDL) support, P&T Committee and DUR Board activities, academic detailing, population health, provider engagement, quality improvement, and continuous program improvement.
Your role in our mission- Support PA program builds by translating approved clinical criteria, coverage requirements, client rules, and workflow needs into build requirements.
- Partner with cross-functional teams to configure PA workflows, clinical logic, renewals, letters, routing, reporting, and operational processes.
- Create and maintain test scenarios, cases, validation documentation, and requirements traceability.
- Participate in QA, unit, integration, UAT, regression, and production testing for PA builds and updates.
- Validate PA workflows and clinical logic against approved policies, client requirements, regulations, and operational expectations.
- Identify and document configuration issues, workflow gaps, risks, and clinical inconsistencies; support resolution efforts.
- Support production readiness by ensuring requirements, testing, documentation, reporting, procedures, and approvals are complete.
- Maintain PA criteria, drug class reviews, clinical policies, and evidence-based materials.
- Use claims, PA, utilization, quality, and trend data to support analysis, investigations, and program improvements.
- Support clinical program operations, including PDL, provider engagement, adherence, safety, specialty pharmacy, quality, and population health initiatives.
- Provide senior-level clinical and operational guidance to improve quality, compliance, workflows, and program performance.
- Mentor team members on PA workflows, configuration, testing, clinical rationale, and best practices.
What we're looking for- Active pharmacist license in good standing required.
- PharmD preferred; Bachelor of Pharmacy degree accepted.
- Preferred: 7 or more years of progressive experience in clinical pharmacy, managed care, PBM, Medicaid pharmacy, prior authorization, pharmacy operations, or related clinical program operations.
- Hands-on experience supporting prior authorization builds, clinical criteria implementation, pharmacy benefit or PA configuration, workflow setup, operational requirements, or system-enabled clinical programs strongly preferred.
- Experience participating directly in QA, unit testing, system integration testing, user acceptance testing, regression testing, defect review, production validation, or implementation readiness activities strongly preferred.
- Experience translating clinical policy, coverage criteria, client requirements, regulatory expectations, and operational workflows into build requirements, configuration inputs, test cases, and validation documentation preferred.
- Strong knowledge of Medicaid pharmacy programs, managed care pharmacy, PBM operations, state and federal requirements, regulatory expectations, and pharmacy-related Medicaid requirements preferred.
- Experience supporting P&T Committee activities, DUR Board activities, PDL management, DUR initiatives, academic detailing, population health, clinical quality, provider outreach, or clinical program improvement preferred.
- Experience working cross-functionally with clinical, operations, configuration, technology, reporting, product, account management, client-facing teams, and leadership stakeholders.
- Proficiency with Microsoft Office products and ability to quickly learn proprietary systems, workflow tools, reporting platforms, and configuration or testing tools.
What you should expect in this role- Remote work available anywhere within the United States
- Benefits begin on Day One
Applications will be accepted through October 8, 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.
