Senior Pharmacy Analyst - WI

Summary

As a Senior Pharmacy Analyst - WI at Gainwell, you can contribute your skills as we harness the power of technology to help our clients improve the health and well-being of the members they serve — a community’s most vulnerable. Connect your passion with purpose, teaming with people who thrive on finding innovative solutions to some of healthcare’s biggest challenges. Here are the details on this position.

Your role in our mission

• Working under the supervision of the Pharmacy Benefit Manager within the Bureau of Clinical Policy and Pharmacy and serves as an embedded resource on the pharmacy team.
• The pharmacy section develops and implements drug coverage and reimbursement policies for outpatient drugs.
• This position collaborates with a team of policy analysts, systems analysts, and clinical staff.
• Primary responsibility is for the assessment, monitoring, and ongoing maintenance of the drug reference file, which includes items covered under the pharmacy benefit and physician-administered drugs. 
• Serves primarily as an information and data analyst for the drug reference file and is responsible for the evaluation and ongoing management needed for accurate maintenance of the drug reference file and its functionality within Wisconsin’s Medicaid Management Information System (MMIS). 
• Ongoing activities include, but are not limited to, drug file data maintenance, analysis, research, and published data table maintenance.
• Long-term activities include analyzing proposed changes to the drug reference file, developing alternatives, and proposing initiatives to improve the quality and efficiencies of the drug reference file.

What we're looking for

• 6 or more years of experience as Business Analyst in Healthcare / Pharmacy Industry including 3 or more years of Medicaid and Medicare experience 
• Access database and Medicaid Pharmacy Benefit experience is a plus
• Experience in Pharmacy reimbursement and understanding of drug coverage rules 
• Experience as a systems business analyst 
• Understanding of National drug codes (NDC) 
• Experience with drug claims processes 

What you should expect in this role

• Remote residing within the state of WI- occasional in office training may occur
• Video cameras must be used during all interviews, as well as during the initial week of orientation

• The deadline to submit applications for this posting is July 30, 2026

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