Prior Authorization Pharmacist

Gainwell Technologies; Ohio; Remote; USD 90,000 - 130,000; Full time

Job summary

Gainwell Technologies is seeking a Prior Authorization Pharmacist to utilize innovative technologies to improve health outcomes. You will evaluate prescriptions, monitor claims, consult with physicians, and contribute to quality improvement. This role offers the opportunity for career growth while delivering impactful healthcare solutions.

Benefits

Flexible vacation policy

401(k) employer match

Comprehensive health benefits

Educational assistance

Qualifications

• Licensed pharmacist required.
• Experience in clinical pharmacy setting preferred.
• Knowledge of specialty medications essential.

Responsibilities

• Evaluate drug reviews based on evidence-based research.
• Monitor prescription claims and track contact with physicians.
• Write consultation and intervention scripts for improvement processes.

Skills

Analytical expertise

Research expertise

Communication skills

Education

Licensed Pharmacist

5+ years in clinical pharmacy

Job description

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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 Prior Authorization Pharmacist 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

Gainwell empowers you through innovative, purpose-built technologies and solutions to refine your skills and help deliver better health outcomes.

• Evaluate drug and drug class reviews following evidence-based research and processes widely accepted by the medical community
• Show your expertise by monitoring prescription claims data seen as exceptions to develop relevant retrospective drug utilization review (DUR) initiatives; present them to leadership
• Enhance your knowledge in this area by consulting physicians and prescribers identified as outliers, tracking contact attempts and documenting consultation results
• Help write consultation and intervention scripts to support continuous improvement and quality improvement processes
• Maintain up-to-date knowledge of medications, drugs and prescribing practices; advise Gainwell leaders based on your knowledge and expertise
• Assist Gainwell leadership in reviewing clinical criteria and Preferred Drug List (PDL) recommendations used to make coverage and PDL placement decisions
  
  

What we're looking for

• Must be a licensed pharmacist
• 5 or more years of experience in a clinical pharmacy setting, with managed care pharmaceutical service experience a plus
• Knowledge of current research and best practices relating to specialty medications
• Analytical and research expertise to conduct drug class and clinical reviews involving prescribing behavior to reach pragmatic conclusions
• Strong written, oral, and clinical communication skills to collaborate with physicians, prescribers, pharmacists, and Gainwell leadership
• A caring people leader who understands their role on a team and can effectively delegate tasks
  
  

What you should expect in this role

• Opportunities to travel through your work (0-10%)
• This position is remote and available to candidates located within the United States.
• The deadline to submit applications for this posting is June 6, 2025.
  
  

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.

Seniority level

• Seniority level

  Mid-Senior level

Employment type

• Employment type

  Full-time

Job function

• Job function

  Health Care Provider

• Industries

  IT Services and IT Consulting

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