Principal Medicaid Pharmacy Strategist, PDL, Pricing & Contracting

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

📋 Description

• Assist in formulating the Medicaid Preferred Drug List (PDL) strategy through the analysis of drug products, clinical criteria, utilization, pricing, and rebate opportunities.

• Perform financial analyses utilizing drug pricing, utilization, and Medicaid rebate data to inform formulary and coverage recommendations.

• Assess clinical criteria, prior authorizations, and pharmacy benefit requirements to enhance access, cost efficiency, and rebate outcomes.

• Examine utilization, expenditures, pricing trends, and supplemental rebate offers to create client recommendations.

• Develop reports, forecasts, and analytical models using advanced Excel and extensive datasets.

• Communicate findings to clients and committees, converting complex clinical and financial data into actionable recommendations.

• Work collaboratively with cross-functional teams to execute PDL, rebate, and pharmacy program strategies.

• Keep track of market developments, verify program data, and ensure accurate analytical documentation.

⛳️ Requirements

• Must be a licensed Pharmacist (RPh or PharmD) in the U.S.

• Minimum of 5 years of pharmacy experience, including areas such as Medicaid pharmacy, managed care, PBM operations, and formulary management.

• In-depth knowledge of Medicaid pharmacy programs, encompassing PDLs, utilization management, prior authorization, claims adjudication, and pharmacy benefit operations.

• Familiarity with drug pricing, Medicaid rebates, supplemental rebates, pharmaceutical contracting, and financial analysis.

• Experience in developing or reviewing formularies, PDLs, prior authorization, and utilization management criteria.

• Proficient in Microsoft Excel, particularly in analyzing large datasets and financial modeling.

• Capability to convert clinical, pricing, utilization, and rebate data into effective pharmacy benefit recommendations.

• Preferred: Experience in supporting state Medicaid PDL programs, Medicaid supplemental rebate programs, rebate pools, or multi-state contracting initiatives.

• Strong analytical and problem-solving abilities with a track record of identifying and reconciling data discrepancies across various sources.

• U.S. work location is required.

🏝️ Benefits

• Flexible working hours.

• Emphasis on work-life balance.

• Opportunities for continuous learning and career advancement.

• Flexible vacation policy.

• 401(k) employer match.

• Comprehensive health benefits.

• Educational assistance.

• Access to leadership and technical development academies.

• Up to 10% travel.