SummaryThe PBM Clinical Account Manager is a visible, client-facing role within the Gainwell Pharmacy Center of Excellence. This key role will be responsible for the clinical and financial strategy and oversight of the PBA services operations teams including, but not limited to, clinical, cost of care, operational, claims, and other functions as needed to monitor KPIs, SLAs, productivity metrics, and appropriate staffing levels to ensure that all contractual obligations are met, while guiding process improvement and identifying efficiencies. The individual will be expected to recommend and evaluate the effectiveness of company performance in relation to contracts, delivery, and client intent. A key function of this role will be developing and presenting monthly and quarterly business review data and insights. The manager is responsible for ensuring all pharmacy-related deliverables are met on time and that quality meets client expectations. The ideal candidate will demonstrate leadership qualities, possess broad knowledge of clinical operations and pharmacy benefit administration services, and maintain a commitment to delivering exceptional client service. This role requires the ability to adapt to client requests and support staff as needed, including assisting with operational tasks.
Your role in our mission- Act as the primary point of contact for the state Medicaid Pharmacy Director, state leadership, and staff
- Serve as a primary point of contact responsible for the hiring, onboarding, and training of new pharmacy operations staff, as well as ongoing staff development
- Provide holistic oversight of all account clinical operations contractual activities including clinical activities, prior authorization, and Medicaid drug rebate processes
- Accountable for ensuring all services are provided timely and accurately, including assisting staff during high-volume demands or low staffing situations
- Subject matter expert in state client benefits, financial reporting, and cost of care initiatives
- Ownership of weekly, monthly, and quarterly pharmacy business review data and presentations
- Accurately track all metrics and initiatives for timely and accurate delivery, meeting all client expectations and ensuring timely updates and presentations to clients
- Review and provide feedback to staff and leadership on monthly and quarterly operations reports
- Manage oversight of operations staff productivity and performance, including preparation and delivery of staff performance reviews and evaluations, and compliance with audit control objectives
- Provide coaching and feedback to staff on conduct and performance, and support skill development and professional growth that will lead to improved outcomes
- Work with operations and client delivery team leaders to help ensure all monthly and quarterly pharmacy Service Level Agreements (SLAs) are accurate and completed on time
- Ensure pharmacy service policies and procedures are up to date
- Develop subject matter expertise in industry best practices, process improvement, and customer service standards of excellence
- Assist and/or lead special projects and ad-hoc client requests as required
- Foster a positive team environment by upholding corporate culture and values
- Initiate development of clinical operations process improvements, organizational structure, and implementation of technology to increase operational efficiencies and drive quality improvements
- Provide oversight, management, and supervision of subcontracted vendors to ensure expectations are being met and quality service is being provided
- Proactively lead the performance and direction of clinical pharmacy services
What we're looking for- PharmD (preferred) or Bachelor of Pharmacy degree with a master's degree in a related field
- Active, unrestricted Pharmacist license required; Texas Pharmacist license preferred but not required
- 6+ years of experience in PBM or MCO Medicaid
- 5+ years of operational leadership experience, including managing teams and driving performance
- Account management experience working with state leaders and key stakeholders
- Experience with Medicaid program management (preferred)
- Experience with workforce management tools and productivity tracking (preferred)
- Experience with P&T Committee, PDL, and DUR Board administration
- Significant experience coordinating and collaborating with work teams preferred
What you should expect in this role- 10-20% travel
- Remote within the U.S.
- Texas-based candidates preferred, but not required
Applications for this posting will be accepted until June 26, 2026.
The pay range for this position is $150,000.00 - $190,000.00 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.
