Clinical Pharmacist-Preferred Drug List Specialist:
Change Healthcare Inc.

Change Healthcare Inc.
London ENG
Clinical Pharmacist - Preferred Drug List Specialist

Overview of Position

As part of Change Healthcare's Pharmacy Benefit Administration (PBA) business unit, the PBM Clinical Pharmacist will serve as the Preferred Drug List (PDL) specialist, create, design, and manage the PDL for the PBA's Cabinet for Health and Family Services (CHFS) Kentucky Fee-for-Service (FFS) Medicaid client. The PDL Specialist must attend meetings and make presentations on behalf of CHFS as requested. Must have the ability to provide recommendations to the Commonwealth for PDL status, after analyzing both federal and supplemental rebates, potential market shifts, and utilization criteria. The PDL Specialist will assist the data analysts by providing clinical criteria for reporting. The PDL Specialist serves as the Subject Matter Expert (SME) and will be accountable for preferred drug list (PDL) design and all clinical reporting. This position will also be accountable for strategy development and execution to optimize mandatory Federal, State Supplemental and Medical Supply rebate revenue. The PDL Specialist supports and serves as back-up for the Pharmacy Account/Contract Manager and Clinical Account Manager as appropriate.

This position acquires, analyzes and maintains information regarding pharmacy benefits management best practices and coordinates all reporting requirements pertaining to the PDL. This position will be based in the CHFS office in Frankfort. Initially, the position may be remote due to Covid-19 restrictions.

What will be my duties and responsibilities in this job?

* Actively support the Pharmacy Account Contract Manager and Clinical Account Manager
* Perform Subject Matter Expert (SME) responsibilities for all PDL activities and Clinical Criteria, including inquiries and correspondence
* Responsible for management and oversight of the PDL and Clinical Criteria sections on the Provider and Member web portals
* Lead efforts to identify and quantify opportunities and to develop workable strategies to address cost containment and pharmacy benefit design best practices to optimize the financial management of the KY FFS Medicaid pharmacy benefit
* Analyze paid claims data and prior authorizations to assess the need for changes
* Advise and assist with configuration of PDL elements, step therapy requirements, automated prior authorization criteria and all other PDL management criteria
* Pharmacy and medical claim data mining and analysis
* Analysis and reporting of key clinical pharmacy benefits metrics and success measures
* Assist in coordinating specialty pharmacy and physician administered drug program
* Coordinate strategy development and execution to optimize mandatory Federal and State supplemental rebate revenue
* Coordinate Prior Authorizations. Responsible for monitoring prior authorization trends and submitting clinically and financially sound recommendations to the State

What are the requirements needed for this position?

* Licensed, registered Kentucky pharmacist in good standing
* Requires at least 2 years of experience in Medicaid, Medicare, or Commercial plans
* At least 3 years of management experience with Medicaid or private sector health care payer
* Strong analytical and data mining skills
* Knowledge of claims processing systems, including Medicaid, drug information systems, hospital, home infusion therapy, pharmacy related aspects of long-term care facilities, and community pharmacy practices

What other skills/experience would be helpful to have?

* Pharm.D. degree
* Specialty pharmacy and physician administered drug experience
* Knowledge of fiscal management and cost containment strategy development of Medicaid or other managed care pharmacy benefit

What are the working conditions and physical requirements of this job?

General office demands

How much should I expect to travel?

Employees in roles that require travel will need to be able to qualify for a company credit card or be able to use their own personal credit card for travel expenses and submit for reimbursement.

Join our team today where we are creating a better coordinated, increasingly collaborative, and more efficient healthcare system!

Equal Opportunity/Affirmative Action Statement

Change Healthcare is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, age, sex, sexual orientation, gender identity, genetic information, national origin, disability, or veteran status. To read more about employment discrimination protections under federal law, read EEO is the Law at and the supplemental information at

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Change Healthcare maintains a drug free workplace and conducts pre-employment drug-testing, where applicable, in accordance with federal, state and local laws.