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Job Description
Summary
The Clinical Pharmacist will be responsible for overseeing the day-to-day operations of the pharmacy operations and drug rebate operations teams.
This position will work directly with the account Business Process Services Manager (BPS) the state Medical Director to operate the Medicaid prescription drug program within state budget and according to legislative requirements and laws.
Your role in our mission
Manage the Gainwell Pharmacy Team to maintain all aspects of the PBM and Drug Rebate services for the State including:
- Providing all aspects of pharmacy claim processing through the Gainwell Pharmacy Services Module
- Coordinating a Prospective and Retrospective Drug Utilization Review program
- Oversee the Gainwell clinical team responsible for evaluating drug prior authorization reviews and providing clinical support.
- Providing pharmacy knowledge needed for the account Medicaid Drug Rebate Program operations.
- Acting as the subject matter expert for escalated pharmacy calls from providers.
- Assisting the state with pharmacy audits using claim details from the system
- Providing ongoing training to pharmacy providers as needed
- Producing annual reports as well as other executive administration duties as they pertain to the State pharmacy program.
Essential Functions:
- Serve as the point of contact with the State Medical Director and State staff.
- Primary liaison between the Account BPS and the Gainwell Pharmacy Team.
- Oversight of all PBM and Drug Rebate services performed by Gainwell including supervision of the account Leadership/Managers.
- Responsible for working with State staff on Pharmacy-related issues, policy implementation, modernization, and program management.
- Responsible for making clinical decision on pharmacy issues referred to Gainwell from the State.
- Oversee Prospective and Retrospective drug utilization review programs for the State including assisting the State in completing the annual CMS DUR Report.
- Oversee Drug Rebate team and operations management.
- Produce status reports on PBM Drug Rebate operations as required by State contract requirements.
What we’re looking for
- Active Rhode Island pharmacist license
- PharmD or Bachelor of Pharmacy degree
- At least two (2) years of experience working in a clinical setting or pharmacy benefit management system.
- Knowledge of Medicaid at the state and/or federal level.
- Knowledge of pharmacy-related aspects of Medicaid.
- Working knowledge of HIPAA regulations and requirements.
Knowledge, Skills, Abilities:
- Ability to communicate succinctly and accurately in both written and verbal English.
- Ability to work independently and in a team environment.
- Ability to work effectively and efficiently under stringent timelines.
- Ability to analyze and resolve difficult logic and processing issues.
- Excellent organizational, written and oral communication skills
- Maintain confidentiality and comply with Health Insurance Portability and Accountability Act (HIPAA)
- Proficient PC abilities (basic knowledge in MS Office), work organization, and problem resolution skills.
What you should expect in this role
- Opportunities to travel through your work (0-10%)
