Title: Prior Authorization Pharmacist - Oregon Medicaid (Remote)

Location: United States

Job Description:

Any city, OR, US, 99999

Req ID: 39163

Work Mode: Virtual (Exception only)

It takes great medical minds to create powerful solutions that solve some of healthcare’s most complex challenges. Join us and put your expertise to work in ways you never imagined possible. We know you’ve honed your career in a fast-moving medical environment. While Gainwell operates with a sense of urgency, you’ll have the opportunity to work more flexible hours. And working at Gainwell carries its rewards. You’ll have an incredible opportunity to grow your career in a company that values work-life balance, continuous learning, and career development.

Summary

The Prior Authorization (PA) Pharmacist is responsible for reviewing prior authorization requests from providers to ensure safe and effective medication utilization. The PA pharmacist will work with internal and external stakeholders in evaluating and continually developing a strategy for Utilization Management.

Your role in our mission

• Review Prior Authorization requests from medical professionals to ensure alignment with Preferred Drug List (PDL) criteria and current clinical guidelines
• Support Peer to Peer discussions with medical providers to discuss Prior Authorization reviews
• Collaborates on the refinement of consultation scripting; solicits and utilizes input from those contacted toward scripting improvements
• Contributes to the success of the Clinical Call Centers and Prior Authorization department by assisting with the implementation and management of both written and verbal communications to members and physicians. Is available for consultation on pharmacy-related questions and issues for others within the organization
• Contributes to program improvements by using continuous quality improvement processes, by being proactive in identifying opportunities and by contributing on-going consultation and collaboration with product leaders
• Upholds clinical integrity of pharmaceutical solutions by staying up to date on medication information, clinical guidelines, contributing to the identification of pharmacy program best practices, and collaborating with Medical Directors, Clinical Pharmacist, and Clinical Pharmacist to provide pharmacy expertise
• Collaborate internally with pharmacy team (Pharmacy Manager, Clinical Pharmacists) to identify trends or areas to explore with the intent of identifying new drugs and therapeutic classes needing utilization management
• Other duties as assigned
• Contributes creative solutions to improve operational efficiency and effectiveness of pharmacy team

What we're looking for

• PharmD or B.S. in Pharmacy
• Registered Pharmacist with unrestricted respective State Licensure
• 4 years’ experience in clinical pharmacy
• Strong verbal and written communications skills
• Highly skilled with Microsoft Office products and ability to quickly learn proprietarysyst ems
• Experience in the coordination of and collaboration of work teams preferred
• Ability to perform clinical reviews using relevant compendia and clinical trial data
• Managed care and/or prior authorization experience a plus
• Strong research and implementation skills in practical settings
• Analytical skills which can translate into practical and pragmatic recommendations
• Strong team orientation with respect for all members.
• People skills are essential that allow for successful consultation and collaboration with internal and external stakeholders who do not directly report to this job.
• Prior call center experience preferred

What you should expect in this role

• Location: Remote, United States
• Work Environment: Dedicated, private home office that is HIPAA compliant and free from distractions
• Schedule: 9:00 AM - 5:00 PM PT, including select holidays and occasional weekend on-call support
• Technology Requirements: Reliable high-speed internet connection required

The pay range for this position is $90,900.00 - $129,900.00 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.