PBM Implementation Pharmacist

Gainwell Technologies

PBM Implementation Pharmacist leading clinical setup of Pharmacy Benefit Management accounts and serving as a clinical SME. Collaborating with pharmacy and engineering teams to ensure accurate implementations and configurations.

Posted 6/19/2026full-timeRemote • Illinois • 🇺🇸 United StatesMid-LevelSenior💰 $113,700 - $162,400 per yearWebsite

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

pharmacy implementationsdrug reference domainsclaims processingautomated PA rule setselectronic prior authorizationdata conversionNCPDP standardsFirst Databank drug hierarchiesMedispan hierarchiesMedicaid pharmacy benefit management

Soft Skills

leadershipcommunicationrisk managementteam unitystatus reportingstakeholder engagementproblem-solvingorganizational skillscollaborationsubject matter expertise

Certifications & Qualifications

active pharmacist license

Industry Keywords

Medicaidpharmacy benefit managementpoint-of-sale (POS)drug rebate product developmentRFP responsesclinical domain activitiesoperational readinesshypercare phasesstate client specificationspharmacy business analyst

Tech Stack

Tools & technologies

Unity

About the role

Key responsibilities & impact

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 client
Track and document progress 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 all 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 unity across the pharmacy business and stakeholders on all Gainwell pharmacy implementations
Participate in corporate pharmacy team meetings

Requirements

What you’ll need

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 point‑of‑sale (POS) pharmacy claim processing is required
Experience and knowledge of First Databank (FDB) drug hierarchies, drug reference files, and prospective DUR parameters is required; understanding of Medispan hierarchies is preferred

Benefits

Comp & perks

generous, flexible vacation policy
401(k) employer match
comprehensive health benefits
educational assistance
leadership and technical development academies