Job Description

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 ​Clinical Pharmacist at Gainwell, you can contribute your skills as we harness the power of technology to help our clients improve the health and well-being of the members they serve — a community’s most vulnerable. Connect your passion with purpose, teaming with people who thrive on finding innovative solutions to some of healthcare’s biggest challenges. Here are the details on this position.

Join our dynamic Pharmacy Center of Excellence (COE) as a Clinical Pharmacist, where you’ll play a pivotal role in driving data-informed clinical strategies, improving patient outcomes, and supporting pharmacy benefit operations. This is a high-impact, client-facing role that blends clinical expertise with data analytics and cross-functional collaboration. 

Your role in our mission

• Utilization Management: Reviews clinical and pricing data to support strategies and provide detailed reporting analysis.
• Retro DUR Initiatives: Monitors prescription claims and prescribing outliers through internal/external data analysis. Develops Retrospective DUR initiatives and presents methods, interventions, communication, and outcomes to the P&T or DUR Board.
• Telephonic Consultations/Interventions: Contacts prescribers identified as outliers to provide coaching and review prior authorizations, identifying opportunities for intervention.
• Intervention Tracking and Documentation: Tracks contact attempts and outcomes per operational procedures. Documents consultations and maintains required records.
• Operations: Supports pharmacy program operations by managing communications with prescribers, maintaining edits/data elements, and providing consultation on pharmacy-related issues (e.g., health coaches, care managers). Updates program engine, coding, consultation sheets, and outreach as needed.
• Quality Improvement: Uses continuous quality improvement processes, identifies opportunities, and collaborates with product leaders to enhance programs.
• Medical/Clinical: Maintains clinical integrity by staying current on medication information, identifying best practices, collaborating with Medical/Clinical Directors, and providing pharmacy expertise across the organization.
• Other Duties: Provides creative solutions to improve operational efficiency and overall effectiveness of the pharmacy team.

Job Description

• Primary duties: Evaluate prescription claims and outlier prescribing practices to develop Retrospective DUR initiatives; present methods, interventions, communication, and outcomes to the P&T or DUR Board.
• Additional duties: Assess utilization management criteria and impact, support configuration needs, develop client clinical recommendations, research policy drivers, and coordinate with operations, claims, network, reporting, and other internal teams as needed.

What we're looking for

• 5+ years of experience in pharmacy benefit management or managed care.

• Strong knowledge of Medicaid (state and federal).

• Licensed pharmacist.

• Clear, accurate communication skills (written, verbal, and presentations).

• Ability to manage multiple projects simultaneously.

• Experience evaluating healthcare data and outcomes.

• Proven leadership to drive results across PBM through influence and collaboration.

• Knowledge of pharmacy claims lifecycle, clinical operations, call centers, medication pricing, NCPDP standards, financial management, and managed care regulations.

• Ability to maintain confidentiality and comply with HIPAA.

• Proficient in MS Office, organizational skills, and problem-solving.

• Skilled in virtual platforms (Teams, Skype, Zoom, etc.).

What you should expect in this role

• Remote role (within the U.S.)

• Up to 25% travel required

• Core hours aligned to Eastern Standard Time (EST)

Applications for this posting will be accepted until November 14, 2025.

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#LI-REMOTE

The pay range for this position is $130,000.00 - $160,000.00 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. 

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