Job Description
This description is a summary of our understanding of the job description. Click on 'Apply' button to find out more. Role Description
This role involves supporting the clinical, operational, and financial PDL needs of the Delaware (DE) Medicaid Fee-for-Service line of business. • Manage the implementation, maintenance, and expansion of the Preferred Drug List (PDL) • Ensure adjudication and related communications reflect the latest changes • Monitor drug file-related changes such as new drugs, new generics, and discontinuations • Develop PDL-related prior authorization criteria • Identify needed therapeutic class reviews (TCRs) and assist with their creation and update • Analyze net bolthires comparisons and monitor Client utilization and market share trends • Operationalize the program and identify areas for improvement • Work cross-functionally to implement, update, and maintain PDL-related information in the Pharmacy Services Module Qualifications • PharmD or commensurate experience • 3+ years of experience in pharmacy benefits management or managed care • Experience working in Medicaid, healthcare technology, and/or pharmacy analytics • Deep clinical and operational expertise • 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 Requirements • Excellent public speaking abilities • Proven experience managing formularies from clinical, operational, and financial perspectives • Strong personal computer and business solutions software skills • Proven ability to interact with varied internal and external stakeholders • Proven ability to interface with and manage Account and Client relationships Benefits • Generous, flexible vacation policy • 401(k) employer match • Comprehensive health benefits • Educational assistance • Leadership and technical development academies to help build skills and capabilities Company Description 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.
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