Principal Clinical Pharmacist

Gainwell Technologies

. Support prior authorization program builds by translating approved clinical criteria, coverage requirements, client rules, and workflow needs into build requirements .

Posted 9/17/2026full-timeRemote • United StatesLead💰 $113,700 - $162,400 per yearWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates expertise in prior authorization program builds, clinical criteria implementation, and operational processes, with a strong focus on compliance and quality improvement in pharmacy operations. Proficient in translating clinical policies and requirements into actionable build specifications and testing documentation.

Highest-signal resume keywords

Active Pharmacist LicensePrior Authorization BuildsClinical Criteria ImplementationQA and Testing ExperienceMedicaid Pharmacy Programs

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Clinical PharmacyPharmacy Benefit ManagementWorkflow ConfigurationTest Case DevelopmentValidation Documentation

Soft Skills

Cross-Functional CollaborationMentoringProblem-Solving

Tools & Technologies

Microsoft OfficeWorkflow ToolsReporting Platforms

Certifications & Qualifications

PharmDBachelor of Pharmacy Degree

Industry Keywords

Managed CarePBM OperationsPrior AuthorizationClinical Program OperationsPopulation Health Initiatives

About the role

Key responsibilities & impact

Support prior authorization program builds by translating approved clinical criteria, coverage requirements, client rules, and workflow needs into build requirements
Partner with cross-functional teams to configure PA workflows, clinical logic, renewals, letters, routing, reporting, and operational processes
Create and maintain test scenarios, test cases, validation documentation, and requirements traceability
Participate in QA, unit, integration, UAT, regression, and production testing for PA builds and updates
Validate PA workflows and clinical logic against approved policies, client requirements, regulations, and operational expectations
Identify and document configuration issues, workflow gaps, risks, and clinical inconsistencies; support resolution efforts
Support production readiness by ensuring requirements, testing, documentation, reporting, procedures, and approvals are complete
Maintain PA criteria, drug class reviews, clinical policies, and evidence-based materials
Use claims, PA, utilization, quality, and trend data to support analysis, investigations, and program improvements
Support clinical program operations, including PDL, provider engagement, adherence, safety, specialty pharmacy, quality, and population health initiatives
Provide senior-level clinical and operational guidance to improve quality, compliance, workflows, and program performance
Mentor team members on PA workflows, configuration, testing, clinical rationale, and best practices

Requirements

What you’ll need

Active pharmacist license in good standing required
PharmD preferred; Bachelor of Pharmacy degree accepted
Preferred: 7 or more years of progressive experience in clinical pharmacy, managed care, PBM, Medicaid pharmacy, prior authorization, pharmacy operations, or related clinical program operations
Hands-on experience supporting prior authorization builds, clinical criteria implementation, pharmacy benefit or PA configuration, workflow setup, operational requirements, or system-enabled clinical programs strongly preferred
Experience participating directly in QA, unit testing, system integration testing, user acceptance testing, regression testing, defect review, production validation, or implementation readiness activities strongly preferred
Experience translating clinical policy, coverage criteria, client requirements, regulatory expectations, and operational workflows into build requirements, configuration inputs, test cases, and validation documentation preferred
Strong knowledge of Medicaid pharmacy programs, managed care pharmacy, PBM operations, state and federal requirements, regulatory expectations, and pharmacy-related Medicaid requirements preferred
Experience supporting P&T Committee activities, DUR Board activities, PDL management, DUR initiatives, academic detailing, population health, clinical quality, provider outreach, or clinical program improvement preferred
Experience working cross-functionally with clinical, operations, configuration, technology, reporting, product, account management, client-facing teams, and leadership stakeholders
Proficiency with Microsoft Office products and ability to quickly learn proprietary systems, workflow tools, reporting platforms, and configuration or testing tools

Benefits

Comp & perks

Benefits begin on Day One
Flexible hours
Work-life balance
Continuous learning and career development
Remote work available anywhere within the United States
Generous, flexible vacation policy
401(k) employer match
Comprehensive health benefits
Educational assistance
Leadership and technical development academies