Great companies need great teams to propel their operations. Join the group that solves business challenges and enhances the way we work and grow. Working at Gainwell carries its rewards. You’ll have an incredible opportunity to grow your career in a company that values your contributions and puts a premium on work flexibility, 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 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. Your role in our mission - Primary point of contact for the Client for all aspects of PDL maintenance, development, expansion, and transformation - Provide PDL subject matter expertise to troubleshoot PDL-related matters - Manage weekly meetings with Client to review clinical, operational and financial impacts to the PDL - Monitor drug-related changes impacting the PDL including, but not limited to, new drugs, new generics, discontinuations, Medicaid Drug Rebate Program (MDRP) changes, price changes, drug shortages - Manage prior authorization criteria for PDL drugs - Code PDL drugs/drug statuses on the PDL coding file - Draft publications (e.g., agendas, minutes, PDL lists) for Client review and public dissemination - Participate in and contribute to clinical and financial drug review meetings - Concisely present complex clinical information to the Client and at Pharmacy and Therapeutics (P&T) Committee meetings - Take responsibility for all PDL-related pre- and post-P&T Committee meeting deliverables - Create strategy recommendations for drugs, therapeutic drug classes, and utilization management edits/criteria - Research and explain clinical and business aspects of drugs and drug strategies to internal business partners and the Client - Stay informed of upcoming changes in the drug market including brand patent expirations, generic and biosimilar releases, new drug therapies, and other industry changes that affect State drug expenditures - Interface with and function as the liaison between internal (e.g., clinical services, account pharmacy team) and external pharmacy stakeholders to ensure end-to-end PDL management - Analyze comprehensive clinical evaluations in conjunction with net cost (using State pricing methodologies and factoring in Federal Medicaid rebates and State supplemental rebates) to inform strategic PDL management recommendations - Support PDL-adjacent financial programs including volume-based agreements, value-based agreements (VBAs), the Brand over Generic program and the preferred diabetic supplies program (DSP) - Create and maintain necessary desk level procedures (DLPs) to support consistency and business continuity - Leverage out-of-the-box (OOTB) technology to optimize efficient management of the 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 - Supports Gainwell Pharmacy Center of Excellence (COE) This posting is intended for pipelining purposes and will remain open to accept applications on an ongoing basis. The pay range for this position is $113,700.00 - $162,400.00 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. Gainwell Technologies defines “wages” and “wage rates” to include “all forms of pay, including, but not limited to, salary, overtime pay, bonuses, stock, stock options, profit sharing and bonus plans, life insurance, vacation and holiday pay, cleaning or gasoline allowances, hotel accommodations, reimbursement for travel expenses, and benefits.

Gillette Children's is seeking an RN for our Nurse Help Line/Provider Access team for a .5FTE. This is a 9-month temporary assignment. The ideal candidate will be available for 8-hour shifts Monday-Friday during department hours: 7:00am - 9:30pm. Current RN License required. Minimum of 3 years of RN experience. This is a remote opportunity; however, the selected candidate must reside in Minnesota or Wisconsin and can work onsite in St. Paul, MN as needed. The 9-month temporary position will be available early June 2026 through March 2027. There is potential for consideration for future openings based on performance and business needs This role is not benefit eligible. Purpose of position The Nurse Help Line RN administers family-centered nursing care to patients, advise patients on health maintenance and disease prevention, and/or provide skilled assistance in navigation of the health care system as appropriate to the developmental, cultural, emotional, and medical, surgical, or rehabilitative needs of the patient and their families. This position will provide a centralized Gillette communication center to patients, providers and staff who are on-call, other care sites and community resources. Specific duties are determined by the work setting and/or the patient population served; however, in all positions at Gillette, serving patients with challenging and complex conditions requires a concentration of specialized staff able to work in highly coordinated teams. We organize care around each patient’s condition which requires staff at multiple levels and across many departments to exhibit exceptional teamwork qualities including communicating efficiently and effectively and adopting the behaviors required for high functioning integrated teams. Compensation & Benefits Information The hourly wage for this opportunity is $39.86-$68.13. Pay is dependent on several factors including relevant work experience, education, certification & licensure, and internal equity. This position is not eligible for benefits. Core Responsibilities and Duties - Patient Care – Delivers patient care over the telephone which optimizes the patient’s health status and outcomes through the use of the nursing process. - Demonstrates thorough assessments. - Creates individualized plans of care that are evidence-based. - Successfully implements interventions. - Effectively prioritizes. - Evaluates patient care based on desired outcomes. - Communicates patient-related nursing data and information to enhance active and informed decision making by patients, families, nurse colleagues, and other healthcare providers. - Effectively triages patient/family/caregiver calls based on urgency and acuity of symptoms, concern or diagnosis. - Collaborates with providers and other members of the health care team in the care of patients. - Reference the medical record for patient information, documentation of patient visits, procedures, and care provided, and to review the plan of care. - Completes timely document all interactions with patients and providers when medical direction is given - Family Centered Care - Provides nursing care and health education reflecting specific patient, family, cultural and community needs. - Identifies the learning needs of the population served. - Implements an effective teaching plan. - Employs strategies to promote health in a safe environment. - Seeks opportunity to evaluate effectiveness of health education as culturally and developmentally appropriate. - Adapts to staffing and department workflow needs based on patient care needs and availability of staff and services. - Autonomous Practice – Exercises independent judgment that influences care and demonstrates understanding of potential clinical implications. - Supervises, delegates, and provides care based on the abilities and limitations of care personnel and patient acuity. - Identifies and incorporates evidence based improvements into own daily work. Qualifications Required - Current Registered Nurse (RN) license through the MN Board of Nursing. - Documentation of completion of a professional nursing program (RN program). - Minimum of 3 years of nursing experience. Knowledge, Skills, and Abilities - Must be interested in working with people with short term or long-term disabilities that begin in childhood. - Demonstrated consistent quality customer service skills. - Demonstrated strength in communication skills, including listening, verbal, and written are essential to provide care by phone. - Demonstrated critical thinking skills. - Basic keyboarding and computer skills - Able to multitask and prioritize. - Able to complete accurate, thorough, specialty-based assessments. - Physically able to work hours required and meet physical demands of the position. Preferred - Bachelor’s degree in nursing or other healthcare related field. - Current certification in CPR-BLS for Health Care Providers by the American Heart Association. • Nursing Specialty Certification relevant to the position. At Gillette Children’s, we foster a culture where every team member feels a sense of belonging and purpose. We are dedicated to building an environment where all feel welcomed, respected, and supported. Our values are embedded at the heart of our culture. We act first from love, embrace the bigger picture, and work side-by-side with our patients, families, and colleagues to help every child create their own story. Together, we work to ensure patients of all backgrounds and abilities reach their full potential. Gillette Children's is an equal opportunity employer and will not discriminate against any employee or applicant for employment because of an individual's race, color, creed, sex, religion, national origin, age, disability, marital status, familial status, genetic information, status with regard to public assistance, sexual orientation or gender identity, military status or any other class protected by federal, state or local laws. Gillette Children’s is a global beacon of care for patients with brain, bone and movement conditions that start in childhood. Our research, treatment and supportive technologies enable every child to lead a full life defined by their dreams, not their diagnoses. To learn more about working at Gillette Children's, please visit https://www.gillettechildrens.org/careers. Gillette Children's participates in the U.S. Department of Homeland Security (DHS) E-Verify program which is an internet-based employment eligibility verification system operated by the U.S. Citizenship and Immigration Services. If E-Verify cannot confirm that you are authorized to work, Gillette will give you written instructions and an opportunity to contact DHS or the Social Security Administration (SSA) to resolve the issue before Gillette takes any further action. Please visit https://www.e-verify.gov/ for further details regarding E-Verify.

We are seeking experienced Medical Biller with a strong background in Appeals and Accounts Receivable (AR) Management. The primary focus of this role will be spine-related AR cleanup, requiring in-depth knowledge of orthopedic billing processes and payer guidelines. Key Responsibilities: - Manage and follow up on Accounts Receivable (AR), with a focus on spine-related claims - Review, analyze, and appeal denied or underpaid claims - Perform AR cleanup by identifying and resolving outstanding balances - Communicate with insurance companies to obtain claim status and resolve issues - Prepare and submit appeal letters with proper documentation - Ensure accurate and timely payment posting follow-ups - Maintain detailed records of all claim activity and resolutions - Collaborate with internal teams to address billing discrepancies and improve processes

We are seeking experienced Medical Biller with a strong background in Appeals and Accounts Receivable (AR) Management. The primary focus of this role will be spine-related AR cleanup, requiring in-depth knowledge of orthopedic billing processes and payer guidelines. Key Responsibilities: - Manage and follow up on Accounts Receivable (AR), with a focus on spine-related claims - Review, analyze, and appeal denied or underpaid claims - Perform AR cleanup by identifying and resolving outstanding balances - Communicate with insurance companies to obtain claim status and resolve issues - Prepare and submit appeal letters with proper documentation - Ensure accurate and timely payment posting follow-ups - Maintain detailed records of all claim activity and resolutions - Collaborate with internal teams to address billing discrepancies and improve processes