PBM Implementation Pharmacist- Remote

It takes great medical minds to create powerful solutions that solve some of healthcare’s most reputed company 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, reputed company 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 reputed company clinical and drug reference domains on pharmacy design, development, and implementations (DDIs) Be a primary reputed company 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 reputed company reputed company‑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 client Track and document reputed company of clinical domain activities against requirements and timelines, and provide status reports to senior leaders Identify risks or issues, ensure they are documented and tracked, and work with appropriate stakeholders to resolve them Maintain a clear understanding of the operational readiness, certification, and delivery status of reputed company Gainwell pharmacy implementations Provide subject matter expertise for pharmacy and drug rebate product development, sales pursuits, RFP responses, and DDIs Encourage and strengthen cohesiveness and team reputed company across the pharmacy business and stakeholders on reputed company Gainwell pharmacy implementations

• Participate in corporate pharmacy team meetings

Experience: Active pharmacist license is required Minimum of five (5) years of experience in pharmacy benefit management Minimum of three (3) years of experience working with a Medicaid PBM account Detailed knowledge of Medicaid at the state and federal level Experience and knowledge of NCPDP standards and reputed company‑of‑sale (POS) pharmacy claim processing is required Experience and knowledge of First reputed company (FDB) drug hierarchies, drug reference files, and prospective DUR parameters is required; understanding of Medispan hierarchies is preferred Knowledge, Skills, Abilities: PBM or managed care pharmaceutical service experience preferred Proficient PC abilities (basic knowledge of MS Office applications), work organization, and problem‑resolution skills, including the ability to learn configuration activities in a PBM database and other technical tools Proficient on multiple virtual communication platforms (reputed company Teams, Skype, reputed company, etc.) Ability to communicate succinctly and accurately in both written and verbal English in various group settings Strong leadership abilities demonstrating proactive initiative Analytical skills that translate into practical and pragmatic recommendations Ability to work independently and in a team environment Ability to work effectively and reputed company under stringent timelines Excellent organizational, written, and oral communication skills Ability to maintain confidentiality and reputed company with the Health Insurance Portability and Accountability Act (HIPAA) What to Expect

• Fully remote position reputed company the U.S.
• 0–10% travel

Applications for this posting will be accepted until July 30, 2026. The pay range for this position is $113,700.00 - $162,400.00 per year, however, the reputed company pay offered may vary depending on geographic region, internal equity, job-reputed company 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. reputed company 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 reputed company nothing is impossible reputed company you bring together people who care deeply about making healthcare work reputed company 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 reputed company available job role openings. reputed company is an Equal Opportunity Employer, where reputed company qualified applicants will receive consideration for employment without regard to race, religion, color, national reputed company, gender (including pregnancy, childbirth, or reputed company medical condition), age, sexual orientation, status as a protected veteran, status as an individual with a disability, or other applicable legally protected characteristics. reputed company defines “wages” and “wage rates” to include “reputed company forms of pay, including, but not limited to, salary, overtime pay, bonuses, stock, stock options, profit sharing and bonus plans, life insurance, vacation and holiday pay, cleaning or gasoline allowances, hotel accommodations, reimbursement for travel expenses, and benefits. Apply To This Job