Preferred Drug List Pharmacist

This is a fully remote position, open to applicants in Michigan.

📋 Description

• Assist with the clinical, operational, and financial needs of the Preferred Drug List for the Delaware Medicaid Fee-for-Service program.

• Supervise the creation, implementation, maintenance, and enhancement of a clinically appropriate and financially sound PDL.

• Ensure that adjudications and related communications are aligned with the current program requirements.

• Track changes in the drug market, including new product launches, generics, biosimilars, discontinuations, pricing fluctuations, shortages, patent expirations, and modifications to the Medicaid Drug Rebate Program.

• Create and maintain prior authorization criteria, drug coding and status documents, therapeutic class reviews, publications, and materials for the Pharmacy & Therapeutics Committee.

• Evaluate clinical evidence, utilization trends, market share, net costs, and rebate factors.

• Formulate strategic recommendations regarding drug coverage, therapeutic classes, and utilization management.

• Act as the primary contact and subject matter expert in Delaware for PDL maintenance, development, expansion, and transformation.

• Deliver clinical and financial proposals to clients and stakeholders within the Pharmacy & Therapeutics Committee.

• Collaborate across clinical, account, pharmacy, and various internal and external teams.

• Promote ongoing enhancements of PDL operations and financial programs, encompassing value-based and volume-based agreements, Brand over Generic strategies, and preferred diabetic supply initiatives.

• Provide support to the Gainwell Pharmacy Center of Excellence.

⛳️ Requirements

• Valid, unrestricted Registered Pharmacist license in any state.

• PharmD or equivalent education and experience.

• Minimum of three years of experience in pharmacy benefits management or managed care.

• Familiarity with Medicaid regulations at the state and/or federal level.

• Background in Medicaid, healthcare technology, and/or pharmacy analytics.

• Experience in supporting Pharmacy & Therapeutics Committee and Drug Utilization Review Board activities.

• Proficient in managing formularies from clinical, operational, and financial viewpoints.

• Excellent analytical, client relationship, communication, and technology skills.

• Capability to convert complex clinical and business data into practical recommendations.

• Willingness to work during Eastern Time Zone hours.

• Commitment to maintaining confidentiality and adherence to HIPAA and relevant Gainwell policies.

• Consistent attendance and the ability to foster effective working relationships with colleagues, clients, members, providers, and customers.

🏝️ Benefits

• Flexible working hours.

• Emphasis on work-life balance.

• Opportunities for continuous learning and career advancement.

• Generous and flexible vacation policy.

• 401(k) employer matching.

• Comprehensive health benefit packages.

• Educational assistance programs.

• Leadership and technical development academies.

• Flexible work arrangements.