Pharmacist - PBM Clinical Account Manager

    Change Healthcare
    Pewee Valley, KY 40056
    Full-time, Part-time
    Similar jobs pay $31.16 - $57.70
    Refer friends, get paid!

    Job Description

    Transforming the future of healthcare isn't something we take lightly. It takes teams of the best and the brightest, working together to make an impact.

    As one of the largest healthcare technology companies in the U.S., we are a catalyst to accelerate the journey toward improved lives and healthier communities.

    Here at Change Healthcare, we're using our influence to drive positive changes across the industry, and we want motivated and passionate people like you to help us continue to bring new and innovative ideas to life.
    If you're ready to embrace your passion and do what you love with a company that's committed to supporting your future, then you belong at Change Healthcare.

    Pursue purpose. Champion innovation. Earn trust. Be agile. Include all. 

    Empower Your Future. Make a Difference.

    Pharmacist - PBM Clinical Account Manager

    Overview of Position

    As part of Change Healthcare's Pharmacy Benefit Administration (PBA) business unit, the PBM Clinical Account Manager will serve as the primary staff clinician, drug information specialist, and Preferred Drug List manager for the PBA's Cabinet for Health and Family Services (CHFS) Kentucky Fee-for-Service (FFS) Medicaid client. The Clinical Account Manager is responsible for preparing clinical reports, drug monographs and preparing and/or presenting information to the various boards and committees.  The PBM Clinical Account Manager also assists the data analysts by providing clinical criteria for reporting. 

    The PBM Clinical Account Manager serves as the account drug information specialist.  This position also serves as the subject matter expert for Healthcare Common Procedure Coding System (HCPCS) and Current Procedural Terminology (CPT) codes pertaining to drugs, including the pricing of procedure coded drugs dispensed by non-pharmacy providers such as practitioner offices and outpatient clinic settings.  The Clinical Account Manager attends professional association meetings as required; manages clinical call center and other issues related to drug prior authorizations; monitors prior authorization trends and makes clinically and financially sound recommendations to the State.  The PBM Clinical Account Manager actively supports prospective and retrospective drug utilization review activities, including reporting.  The position acquires, analyzes and maintains information regarding pharmacy benefits management best practices and coordinates lock-in program activities. Position will be based in the CHFS office in Frankfort, Kentucky.  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 Preferred Drug List (PDL) Pharmacist Specialist
    • Perform Subject Matter Expert (SME) responsibilities for all pharmacy-related matters, including inquiries and correspondence
    • Responsible for management and oversight of the Prior Authorization Clinical Call Center staff
    • 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
    • Coordinate rate-setting and State Maximum Allowable Cost (SMAC) list
    • Coordinate 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
    • Have at least two (2) years of experience as a Clinical Account Manager with similar projects
    • At least three (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?

    • Minimum of a B.S. Pharmacy required but a Pharm.D. Degree is highly preferred
    • Previous Prior Authorization Call Center management experience
    • Specialty pharmacy management 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

    If you need a reasonable accommodation to assist with your application for employment, please contact us by sending an email to with "Applicant requesting reasonable accommodation" as the subject. Resumes or CVs submitted to this email box will not be accepted.

    Click here to view our pay transparency nondiscrimination policy.

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

    Suggested Searches

    Posting ID: 615402119Posted: 2021-03-29Job Title: Pharmacist