Gainwell Technologies

Prior Authorization Pharmacist - Oregon Medicaid (Remote)

Gainwell Technologies • $85K — $121K *
Wrangell, AK 99929In-Person
Healthcare
Less than 5 years of experience
Today
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Job Overview by Ladders

Qualifications

  • PharmD or B.S. in Pharmacy required.
  • Registered Pharmacist with unrestricted state licensure.
  • Minimum four years of clinical pharmacy experience.
  • Proficient in verbal and written communication.
  • Skilled in Microsoft Office and adaptability to new systems.

Responsibilities

  • Review prior authorization requests for adherence to Preferred Drug List criteria.
  • Support peer-to-peer discussions with medical providers regarding authorizations.
  • Refine consultation scripting based on feedback from stakeholders.
  • Assist Clinical Call Center and PA department with communication strategies.
  • Identify opportunities for program improvements through quality processes.
  • Maintain clinical integrity by staying updated on drug information and guidelines.
  • Collaborate with pharmacy teams to identify trends for utilization management.

Benefits

  • Work-from-home flexibility from any U.S. state.
  • Reliable high-speed internet reimbursement.
  • Generous vacation policy for full-time salaried employees.
  • 401(k) matching contributions for retirement savings.
  • Comprehensive health benefits including medical and dental.
  • Educational assistance for professional development.
  • Access to leadership and technical development academies.
Full Job Description
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.

Essential Job Functions
  • 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.
  • Collaborate on the refinement of consultation scripting; solicit and utilize input from those contacted to improve scripting.
  • Contribute 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. Serve as a resource for pharmacy-related questions and issues for others within the organization.
  • Contribute to program improvements by using continuous quality improvement processes, proactively identifying opportunities, and providing ongoing consultation and collaboration with product leaders.
  • Uphold clinical integrity of pharmaceutical solutions by staying up to date on medication information and clinical guidelines, contributing to the identification of pharmacy program best practices, and collaborating with Medical Directors and Clinical Pharmacists to provide pharmacy expertise.
  • Collaborate internally with the 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.
  • Perform other duties as assigned.
  • Contribute creative solutions to improve operational efficiency and effectiveness of the pharmacy team.


Requirements
  • PharmD or B.S. in Pharmacy.
  • Registered Pharmacist with unrestricted state licensure from any state.
  • Four years of experience in clinical pharmacy.
  • Strong verbal and written communication skills.
  • Highly skilled with Microsoft Office products and ability to quickly learn proprietary systems.
  • Expected working hours: 9 a.m. to 5 p.m. Pacific Time, including select holidays and occasional weekend on-call coverage.


Basic Qualifications
  • Experience in the coordination 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 is a plus.
  • Strong research and implementation skills in practical settings.
  • Analytical skills that translate into practical and pragmatic recommendations.
  • Strong team orientation with respect for all members.
  • Strong interpersonal skills that support successful consultation and collaboration with internal and external stakeholders who do not directly report to this role.
  • Prior call center experience preferred.


Work Environment
  • Work-from-home from any U.S. state.
  • Travel approximately 0-10%.
  • Reliable high-speed internet connectivity is required.
  • A dedicated, private, distraction-free, HIPAA-compliant workspace with high-speed internet access is required.


We will accept applications until July 10, 2026.

The pay range for this position is $85,000.00 - $121,400.00 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.

About Gainwell Technologies

Gainwell Technologies offerings including Medicaid Management Information Systems (MMIS), fiscal agent services, program integrity, care management, immunization registry, and eligibility services. With over 50 years of proven experience, Gainwell carries forward a reputation for technological innovation, service excellence, and unparalleled industry expertise in offering clients scalable and flexible health and human services solutions for their most complex challenges.

Gainwell Technologies Careers

There has never been a more opportune time to join Gainwell Technologies, a leader in providing cutting-edge technology solutions. As a hub of innovation and diversity, Gainwell Technologies offers a plethora of job opportunities aimed at enhancing the digital landscape.

Work You’ll Do

Join Gainwell Technologies' esteemed team to assist some of the most prominent organizations in mastering their technological advancements and digital transformations. At Gainwell Technologies, the focus is on leveraging a unique blend of technology, industry expertise, and digital innovation to lead the market. Professionals at Gainwell Technologies are positioned uniquely at the crossroads of technology and consulting, driving leadership and growth in various sectors through transformative solutions.

Gainwell Technologies Professional Growth and Opportunities

The team is dedicated to building a leading-edge environment that fosters professional growth and innovation. Gainwell Technologies is not just about addressing the current needs of the market but also about foreseeing and shaping the future of technology.

Innovative Work

At Gainwell Technologies, employees engage in groundbreaking work at the intersection of technology and practical application. The company is home to a large group of dedicated professionals who are committed to delivering robust solutions on trusted platforms.

Career Advancement

Embark on a career journey with Gainwell Technologies where the sky is the limit. The company supports ambitious professionals with comprehensive training, development programs, and diverse certification opportunities designed to future-proof careers in the technology sector.

Explore Job Opportunities and Culture

Gainwell Technologies is committed to creating a workplace culture that promotes diversity and inclusion, where every team member’s contribution is valued. Explore various job opportunities, from internships to full-time positions, and become part of a team that values innovation and leadership.

The Gainwell Technologies Commitment to Diversity and Professional Development

Gainwell Technologies recognizes the importance of diversity training and professional development in creating a thriving workplace. The company is dedicated to providing employees with the resources they need to succeed in their careers and contribute to the industry effectively.

Stay Connected with Gainwell Technologies Careers

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Learn more about Gainwell Technologies
Size
10,001 employees
Industry
Information Technology
* Ladders Estimates

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