Remote PA Pharmacist for Medicaid Utilization

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

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.