supports efforts in the development of pharmacy solutions programs including prior authorization criteria development
supports prospective and retrospective Drug Utilization Review (DUR) activities by reviewing physician prescribing patterns
provides consultation on pharmacy-related issues to clinical operations representatives
leads and/or supports operational initiatives and projects including strategic planning and implementation
evaluates drug and drug class reviews based on sound, evidence-based research
engages in discussions with practicing physicians and other prescribers to consult on specialty medication prescribing
regularly reviews and monitors prescription claims data and identifies prescribing outliers
works with Gainwell staff to contact prescribers requiring consultation

Registered Pharmacist with active State Licensure
PharmD (preferred) or Bachelor of Pharmacy degree
Minimum of 5 years of experience in clinical pharmacy or PBM
Knowledge of Medicaid at the state and/or federal level
Knowledge of pharmacy-related aspects of Medicaid
Experience with P&T Committee and DUR Board participation
Ability to communicate clearly and accurately in both written and verbal English
Ability to perform clinical reviews using relevant compendia and clinical trial data
Managed care pharmacy experience is a plus
Strong research and implementation skills in practical settings
Strong analytical skills with ability to translate findings into practical recommendations
Strong team orientation with respect for all members
Strong interpersonal skills to support collaboration with internal and external stakeholders
Excellent organizational, written, and verbal communication skills
Maintains confidentiality and complies with HIPAA requirements
Proficient in Microsoft Office applications and ability to learn proprietary systems quickly
Strong organizational and problem-solving skills

Clinical Pharmacist

Key skills