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This is a Full-time position in Newark, DE posted June 9, 2021.

Job Description:


  • The staff pharmacist will, under general direction: provide pharmaceutical expertise to staff and management within a healthcare account.
  • Provide supervision to pharmacy prior authorization/clinical call center to ensure operations are meeting contractual service level agreements; monitor the maintenance of the drug data file to ensure accuracy and currency of files.
  • Act as a liaison to pharmaceutical providers assisting in the adjudication of claims and prior authorizations; recommend and promote beneficial changes to customer programs.
  • Interpret and apply state regulations to claims processes and the State of Delawares Preferred Drug List; participate in customer policy and rate revisions to provider publications; assist in the development of methods and coding systems for computerized processing of claims; represent Gainwell Technologies in professional associations.


  • A current Delaware Pharmacist license and B.S. degree from an accredited college or university are required.
  • At least three (3) years of experience in pharmacy healthcare benefits management, including responsibility for administration of claims processing and payment related activities; Retrospective and prospective Drug Utilization Review


  • Previous or concurrent Drug Rebate operational experience.
  • Previous or concurrent operational experience with state pharmaceutical assistance program or other publicly-financed health program such as Medicaid.
  • Previous or concurrent experience with prior authorizations administration.
  • Experience with claims data analysis.

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