Remote Pharmacist Medical Reviewer – Impact & Growth

Gainwell Technologies; West Sacramento (CA); Remote; USD 100,000 - 140,000; Full time

Benefits offered by this job

Remote work

Flexible vacation policy

401(k) employer match

Comprehensive health benefits

Educational assistance

Job summary

Gainwell Technologies seeks a Medical Reviewer (Pharmacist) to provide pharmacy and clinical expertise supporting Medical Review Services for California healthcare programs. The role includes pharmacy review, claim adjudication, drug rebate activities, TARs, and related Medical Review functions.

It is a full-time remote role with a Monday–Friday schedule, reviewing documentation and collaborating with physicians, pharmacists, nurses, and other clinical staff to ensure timely determinations.

Qualifications

• Current, non-expired pharmacist license from the State of California, in good standing.
• Must not be under suspension from Medicare, Medicaid, or pharmacy practice in California.
• Must not have been previously sanctioned for fraud or abuse.

Responsibilities

• Perform pharmacy and medication-related clinical reviews.
• Support pharmacy claim review and adjudication activities.
• Provide clinical expertise for drug utilization review and drug-related authorization requests.
• Support drug rebate and pharmacy program activities as assigned.
• Review pharmacy documentation for compliance with applicable policies and coverage requirements.
• Provide technical expertise and assistance related to pharmacy review.
• Document findings and recommendations accurately and timely.
• Collaborate with physicians, nurses, pharmacy teams, operations, and other healthcare professionals.
• Maintain knowledge of applicable pharmacy policies and regulatory requirements.

Skills

Pharmacist license (CA)

Clinical pharmacy review

Drug utilization review

Documentation & reporting

Communication skills

Tools

MMIS systems

Job description

Gainwell Technologies seeks a Medical Reviewer (Pharmacist) to provide pharmacy and clinical expertise supporting Medical Review Services for California healthcare programs. The role includes pharmacy review, claim adjudication, drug rebate activities, TARs, and related Medical Review functions.

It is a full-time remote role with a Monday–Friday schedule, reviewing documentation and collaborating with physicians, pharmacists, nurses, and other clinical staff to ensure timely determinations.