Prior Authorization Pharmacist - Oregon Medicaid (Remote)

Gainwell Technologies LLC; Ohio; Remote; USD 91,000 - 130,000; Full time

Benefits offered by this job

Health benefits

401(k) matching

Educational assistance

Flexible vacation policy

Job summary

Gainwell Technologies is seeking a Prior Authorization Pharmacist to review provider PA requests for safe medication use, ensuring alignment with PDL criteria and clinical guidelines.

The role supports clinical call centers, collaborates with Medical Directors and Clinical Pharmacists, and contributes to program improvements through CQI processes. Remote position within the United States.

Qualifications

• ~4 years’ experience in clinical pharmacy.
• Ability to perform clinical reviews using relevant compendia and clinical trial data.
• Experience with managed care or prior authorization is a plus.

Responsibilities

• Review prior authorization requests to ensure alignment with PDL criteria and clinical guidelines.
• Support peer-to-peer discussions with medical providers on PA reviews.
• Assist with communications to members and physicians for PA processes.
• Collaborate with pharmacy team and Medical Directors to improve program efficiency and best practices.

Skills

Clinical pharmacy

Microsoft Office

Clinical reviews

Managed care experience

Research skills

Education

Pharmacy degree

Tools

Microsoft Office

Job description

It takes great medical minds to create powerful solutions that solve some of healthcare’s most complex challenges. 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. The Prior Authorization (PA) Pharmacist is responsible for reviewing prior authorization requests from providers to ensure safe and effective medication utilization. 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
• 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 Pharmacists, 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
• Contributes creative solutions to improve operational efficiency and effectiveness of pharmacy team

S. in Pharmacy

• ~ 4 years’ experience in clinical pharmacy
• ~ Highly skilled with Microsoft Office products and ability to quickly learn proprietarysyst ems
• ~ 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
• ~ Location: Remote, United States

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

Will receive applications until October 30, 2026.

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. 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.

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.