It takes great medical minds to create powerful solutions that solve some of healthcare’s most complex challenges. Join us and put your expertise to work in ways you never imagined possible. We know you’ve honed your career in a fast-moving medical environment. While Gainwell operates with a sense of urgency, you’ll have the opportunity to work more flexible hours. And working at Gainwell carries its rewards. You’ll have an incredible opportunity to grow your career in a company that values work-life balance, continuous learning, and career development.
Summary
As part of the Gainwell clinical pharmacy practice group, the PDL Senior Clinical Manager oversees and streamlines the clinical and operational PDL activities of all of our PDL Clients in the Medicaid Fee for Service Line of Business. This role creates standardized clinical and operational processes for the PDL Clinical Account Managers to follow and be measured by. In addition, the PBM Sr Clinical Manager will be responsible for the clinical and operational activities of one PDL Account. This position will manage a team of clinicians and ensure that adequate training and cross-training is completed. The position will train and mentor new PDL Clinical Account Managers and oversee their performance and growth. The PDL development and maintenance activities include monitoring new drugs, assisting in clinical drug class reviews, and analyzing cost comparisons to develop and maintain Medicaid PDLs. Additional activities include developing PDL related prior authorization criteria, monitoring Client utilization and financial trends and identifying areas for improvement. They will also work with the system teams in implementing, updating, and maintaining PDL information in the Pharmacy Services Module. Operationalization efforts include the correct coding of the weekly PDL and associated formulary files.
Your role in our mission
• Primary point of contact for specific Clients for all aspects of the Preferred Drug List maintenance and development
• Excellent public speaking abilities.
• Ability to present PDL Clinical Information to the Client and at public Pharmacy and Therapeutics Committee meetings in a concise manner
• Responsible for creation and standardization of policies and procedures for Operational, Clinical and Reporting PDL activities and training all PDL Clinical Account Managers.
• Management of PDL Clinical Account Team Members
• Working closely with the PDL and Pricing teams on activities.
• Interfacing with Pharmaceutical Managers, Prescribers and Providers on questions related to the PDL
• Manage PDL and criteria for the purposes of adjudication and publishing of prescription drug lists and websites in line with the decisions from the P&T Committee and DUR Board.
• Monitor for new drugs, new generics, pricing changes and drug shortages on a weekly basis and coding the correct drug statuses to the PDL
• Function as the liaison between many internal and external pharmacy stakeholders to ensure end to end PDL formulary management and prior authorization implementation.
• Contribute and participate in clinical and/or financial committee meetings that manage drug review. Performs drug and class reviews as needed. Creates strategy recommendations regarding drugs, classes, and utilization management edits/criteria.
• Stay informed of upcoming changes in the drug market including Brand patent expirations, generic and bioequivalent releases, new drug therapies, and any other changes in the industry that affect State drug expenditures.
• Participating in proposal response and associated presentations
What we're looking for
• Demonstrated leadership experience and abilities.
• Proven experience managing formularies from a clinical, operational and financial perspective
• Proven Ability to interact with multiple different internal and external stakeholders
• Proven ability to create and standardize policies and procedures that can be utilized by team members to improve efficiency, streamline activities and promote best practices
• Proven ability to lead and manage a team of clinicians
PharmD or commensurate experience.
• 5+ years of experience in pharmacy benefit or managed care experience
• Experience working in Medicaid, healthcare technology, and/or pharmacy analytics is required.
• Deep clinical and operational expertise
• A strategic mindset with a passion for innovation and development of a rapidly growing line of business
• Proven understanding of relevant healthcare regulations (HIPAA, CMS guidelines and best practices) – preferably as related to Medicaid Fee for Service
• Excellent verbal and written communication skills.
• Ability to abide by Gainwell policies.
• Ability to maintain attendance to support required quality and quantity of work.
• Maintain 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 customers.
• Ability to develop, organize, and maintain project plans and agendas.
• Excellent writing skills, ability to develop presentations, brief proposals, protocols, and review guideline documents.
What you should expect in this role
• This position is remote.
• Work Hours: Eastern Time Zone
• Supports Gainwell Pharmacy COE
The pay range for this position is $113,900.00 - $162,700.00 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.
