Preferred Drug List (PDL) Pharmacist

It takes great medical minds to create powerful solutions that solve some of healthcare’s most complex 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, continuous learning, and career development.

Summary

As part of the Gainwell Pricing and Contracting team, the Preferred Drug List (PDL) Pharmacist supports the clinical, operational and financial PDL needs of the Missouri (MO) Medicaid Fee-for-Service line of business. This role manages the implementation, maintenance and expansion of the PDL and ensures that adjudication and related communications reflect the latest changes. The primary responsibility is the development and maintenance of a clinically appropriate and fiscally responsible PDL. Fulfilling this objective entails the following activities: monitoring drug file-related changes such as new drugs, new generics, discontinuations and their impact; developing PDL-related prior authorization criteria; identifying needed therapeutic class reviews (TCRs) and assisting with their creation and update; analyzing net cost comparisons; and monitoring Client utilization and market share trends. Additional tasks include efficiently operationalizing the program; identifying areas for improvement; and working cross-functionally to implement, update, and maintain PDL-related information in the Pharmacy Services Module. Job Functions

• Serve as the primary liaison to the State of Missouri for all PDL development, maintenance, expansion, and strategy
• Provide subject matter expertise on PDL policies, drug criteria, and operational impacts
• Monitor drug market changes (new drugs, generics, pricing, shortages, MDRP updates) and advise on clinical and financial implications
• Manage prior authorization criteria and coding for PDL drugs
• Prepare agendas, meeting materials, and public-facing PDL publications
• Present clinical findings and drug strategy recommendations to the client and P&T Committee
• Coordinate with internal clinical, financial, and pharmacy stakeholders to align decisions and ensure end-to-end PDL execution
• Support PDL-related financial models, including rebate strategies and utilization management programs
• Maintain internal procedures and leverage available technology to streamline PDL operations

What We're Looking For

• Excellent public speaking abilities
• Proven experience managing formularies from clinical, operational and financial perspectives
• Strong personal computer and business solutions software skills
• Proven ability to interact with varied internal and external stakeholders
• Proven ability to interface with and manage Account and Client relationships

Additional Skills/Experience

• PharmD or commensurate experience
• 3+ years of experience in pharmacy benefits management or managed care
• Experience working in Medicaid, healthcare technology, and/or pharmacy analytics is required
• Deep clinical and operational expertise
• Excellent verbal and written communication skills
• Ability to abide by Gainwell policies
• Ability to maintain attendance to support required quality and quantity of work
• Maintain confidentiality and comply with Health Insurance Portability and Accountability Act (HIPAA).
• Ability to establish and maintain positive and effective work relationships with coworkers, clients, members, providers, and customers
• Ability to develop, organize, and maintain project plans and agendas

What You Should Expect In This Role

• This position is remote
• Work Hours: Central Time Zone
• Supports Gainwell Pharmacy Center of Excellence (COE)

This position is for pipeline purposes, and we welcome applications on an ongoing basis. The pay range for this position is $108,500.00 to $155,000.00 per year, however, the base pay offered may vary depending on geographic region, internal equity, job-related 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. All 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 believe nothing is impossible when you bring together people who care deeply about making healthcare work better 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 all available job role openings. Gainwell Technologies is an Equal Opportunity Employer, where all qualified applicants will receive consideration for employment without regard to race, religion, color, national origin, gender (including pregnancy, childbirth, or related medical condition), age, sexual orientation, status as a protected veteran, status as an individual with a disability, or other applicable legally protected characteristics. Apply tot his job Apply To this Job