Remote Prior Authorization Pharmacist — Clinical UM Impact

Gainwell Technologies LLC; Oregon; Hybrid; USD 91,000 - 130,000; Full time

Benefits offered by this job

generous, flexible vacation policy

a 401(k) employer match

comprehensive health benefits

educational assistance

leadership and technical development

Job summary

Gainwell Technologies LLC seeks a Prior Authorization Pharmacist to review clinical documentation and the Preferred Drug List to guide therapy decisions. This role collaborates with internal and external stakeholders to optimize utilization management and patient outcomes.

Responsibilities include PA reviews, peer discussions with providers, and scripting refinements. The position offers remote work within the United States, with flexible scheduling to meet business needs.

Qualifications

• PharmD or B.S. in Pharmacy with relevant specialty experience.
• Registered Pharmacist with active state licensure.
• Four years of experience in clinical pharmacy.
• Experience coordinating and collaborating with work teams preferred.
• Ability to perform clinical reviews using relevant compendia and clinical trial data.
• Managed care pharmaceutical services experience is a plus.

Responsibilities

• Clinical evaluation of medication therapy.
• Review Prior Authorization requests from medical professionals using the PDL Criteria.
• Peer-to-Peer discussions with medical providers on PA reviews.
• Consultations/interventions with prescribers to provide clinical information.
• Interventions refinements and scripting improvements.
• Support the Clinical Call Centers and PA department through communications.
• Contribute to quality improvement and pharmacy program best practices.
• Collaborate with Medical Directors and Clinical Pharmacists to ensure pharmacy expertise.

Skills

Clinical evaluation

Peer discussions

Intervention scripting

Microsoft Office

Education

PharmD or B.S. in Pharmacy

Job description

Gainwell Technologies LLC seeks a Prior Authorization Pharmacist to review clinical documentation and the Preferred Drug List to guide therapy decisions. This role collaborates with internal and external stakeholders to optimize utilization management and patient outcomes.

Responsibilities include PA reviews, peer discussions with providers, and scripting refinements. The position offers remote work within the United States, with flexible scheduling to meet business needs.