Preferred Drug List (PDL) Pharmacist

Great companies need great teams to propel their operations. Join the group that solves business challenges and enhances the way we work and grow. Working at Gainwell carries its rewards. You’ll have an incredible opportunity to grow your career in a company that values your contributions and puts a premium on work flexibility, learning, and career development. SummaryAs part of the Gainwell Pricing and Contracting team, the Preferred Drug List (PDL) Pharmacist supports the clinical, operational and financial PDL needs of the Medicaid Fee-for-Service line of business. This role manages the implementation, maintenance and expansion of the PDL and ensures that adjudication and related communications reflect the latest changes. The primary responsibility is the development and maintenance of a clinically appropriate and fiscally responsible PDL. Fulfilling this objective entails the following activities: monitoring drug file-related changes such as new drugs, new generics, discontinuations and their impact; developing PDL-related prior authorization criteria; identifying needed therapeutic class reviews (TCRs) and assisting with their creation and update; analyzing net cost comparisons; and monitoring Client utilization and market share trends. Additional tasks include efficiently operationalizing the program; identifying areas for improvement; and working cross-functionally to implement, update, and maintain PDL-related information in the Pharmacy Services Module.Your role in our missionPrimary point of contact for the Client for all aspects of PDL maintenance, development, expansion, and transformationProvide PDL subject matter expertise to troubleshoot PDL-related mattersManage weekly meetings with Client to review clinical, operational and financial impacts to the PDLMonitor drug-related changes impacting the PDL including, but not limited to, new drugs, new generics, discontinuations, Medicaid Drug Rebate Program (MDRP) changes, price changes, drug shortagesManage prior authorization criteria for PDL drugsCode PDL drugs/drug statuses on the PDL coding fileDraft publications (e.g., agendas, minutes, PDL lists) for Client review and public disseminationParticipate in and contribute to clinical and financial drug review meetingsConcisely present complex clinical information to the Client and at Pharmacy and Therapeutics (P&T) Committee meetingsTake responsibility for all PDL-related pre- and post-P&T Committee meeting deliverablesCreate strategy recommendations for drugs, therapeutic drug classes, and utilization management edits/criteriaResearch and explain clinical and business aspects of drugs and drug strategies to internal business partners and the ClientStay informed of upcoming changes in the drug market including brand patent expirations, generic and biosimilar releases, new drug therapies, and other industry changes that affect State drug expendituresInterface with and function as the liaison between internal (e.g., clinical services, account pharmacy team) and external pharmacy stakeholders to ensure end-to-end PDL managementAnalyze comprehensive clinical evaluations in conjunction with net cost (using State pricing methodologies and factoring in Federal Medicaid rebates and State supplemental rebates) to inform strategic PDL management recommendationsSupport PDL-adjacent financial programs including volume-based agreements, value-based agreements (VBAs), the Brand over Generic program and the preferred diabetic supplies program (DSP)Create and maintain necessary desk level procedures (DLPs) to support consistency and business continuityLeverage out-of-the-box (OOTB) technology to optimize efficient management of the PDL operationsWhat we're looking forExcellent public speaking abilitiesProven experience managing formularies from clinical, operational and financial perspectivesStrong personal computer and business solutions software skillsProven ability to interact with varied internal and external stakeholdersProven ability to interface with and manage Account and Client relationshipsAdditional Skills/Experience PharmD or commensurate experiencePharmacist license is required.Strong computer skills, including proficiency in Microsoft Office tools, especially Excel.3+ years of experience in pharmacy benefits management or managed careExperience working in Medicaid, healthcare technology, and/or pharmacy analytics is requiredDeep clinical and operational expertiseExcellent verbal and written communication skillsAbility to abide by Gainwell policiesAbility to maintain attendance to support required quality and quantity of workMaintain confidentiality and comply with Health Insurance Portability and Accountability Act (HIPAA).Ability to establish and maintain positive and effective work relationships with coworkers, clients, members, providers, and customersAbility to develop, organize, and maintain project plans and agendasWhat you should expect in this roleThis position is remote0-10% of travel. Supports Gainwell Pharmacy Center of Excellence (COE)This posting is intended for pipelining purposes and will remain open to accept applications on an ongoing basis.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.We believe nothing is impossible when you bring together people who care deeply about making healthcare work better for everyone. Build your career with Gainwell, an industry leader. You’ll be joining a company where collaboration, innovation, and inclusion fuel our growth. Learn more about Gainwell at our company website and visit our Careers site for all available job role openings.Gainwell Technologies is an Equal Opportunity Employer, where all qualified applicants will receive consideration for employment without regard to race, religion, color, national origin, gender (including pregnancy, childbirth, or related medical condition), age, sexual orientation, status as a protected veteran, status as an individual with a disability, or other applicable legally protected characteristics. Gainwell Technologies defines “wages” and “wage rates” to include “all forms of pay, including, but not limited to, salary, overtime pay, bonuses, stock, stock options, profit sharing and bonus plans, life insurance, vacation and holiday pay, cleaning or gasoline allowances, hotel accommodations, reimbursement for travel expenses, and benefits.