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 The PBM Implementation Pharmacist reports to the Director of Clinical Operations and leads the clinical setup of new Pharmacy Benefit Management (PBM) accounts from both system and functional perspectives. This role serves as the subject matter expert for pharmacy services, including benefit plan drug coverage, edit configuration, prospective and retrospective drug utilization review (DUR), prior authorization (PA) criteria and rule configuration, and coordination with the implementation practice team to support successful program implementation for customer organizations. Essential Functions may include: Serve as the primary clinical SME on pharmacy implementations Lead clinical and drug reference domains on pharmacy design, development, and implementations (DDIs) Be a primary point of contact with the state client pharmacy team during the DDI and hypercare phases Ensure benefit plan drug coverages are configured accurately to state client specifications and requirements Validate successful and accurate conversion of pharmacy data from other vendors and stakeholders Ensure all point‑of‑sale (POS) claims processing edits, pricing, return messaging, and configuration meet the business requirements of the client Work with engineering and pharmacy business analyst teams to configure automated PA rule sets and electronic prior authorization (EPA) question sets, including testing scenarios and validation with the
