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Pharmacist

Gainwell

This is a Full-time position in newark, de posted November 26, 2021.

Gainwell Technologies LLC

Summary 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 Delaware’s 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.  

Requirements:

a.    A current Delaware Pharmacist license and B.S. degree from an accredited college or university are required.

b.    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 

Preferred:
a.     previous or concurrent Drug Rebate operational experience

b.     previous or concurrent operational experience with state pharmaceutical assistance program or other publicly-financed health program such as Medicaid; 

c.    Previous or concurrent experience with prior authorizations administration

d.    Experience with claims data analysis

Job Description Qualifications

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