Gainwell Technologies · 18 hours ago
Clinical Pharmacist
Any city, OH, US, 99999
Full-time
Hybrid
Senior Level
$130K/yr - $160K/yr
5+ years expGainwell Technologies is focused on creating powerful solutions for healthcare challenges. As a Clinical Pharmacist, you will drive data-informed clinical strategies, improve patient outcomes, and support pharmacy benefit operations in a client-facing role.
Health CareInformation Technology
Responsibilities
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
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
Qualification
Required
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.)
Benefits
Flexible vacation policy
401(k) employer match
Comprehensive health benefits
Educational assistance
Variety of leadership and technical development academies
Company
Gainwell Technologies
Gainwell Technologies is a provider of Information Technology & Services. It is a sub-organization of Veritas Capital.
10001+ employees
H1B Sponsorship
Gainwell Technologies has a track record of offering H1B sponsorships. Please note that this does not
guarantee sponsorship for this specific role. Below presents additional info for your
reference. (Data Powered by US Department of Labor)
Distribution of Different Job Fields Receiving Sponsorship
Represents job field similar to this job
Trends of Total Sponsorships
2025 (66)
2024 (78)
2023 (56)
2022 (96)
2021 (33)
Funding
Current Stage
Late StageTotal Funding
$1M2023-06-06Grant· $1M
Leadership Team
Paul N. Saleh
President and Chief Executive Officer
Gary Call
Chief Medical Officer
Recent News
bloomberglaw.com
2025-12-12
GlobeNewswire
2025-12-11
Company data provided by crunchbase