Manager, Prior Authorizations (Pharmacist)- Missouri

Gainwell Technologies LLC

1d•$122,200 - $174,600•Remote

About The Position

It takes great medical minds to create powerful solutions that solve some of healthcare’s most complex challenges. Join us and put your expertise to work in ways you never imagined possible. 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. And working at Gainwell carries its rewards. You’ll have an incredible opportunity to grow your career in a company that values work-life balance, continuous learning, and career development. SummaryAs a Prior Authorization Operations Manager (Licensed 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 by 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 missionGainwell empowers you through innovative, purpose-built technologies and solutions to refine your skills and help deliver better health outcomes.

Requirements

5 or more years of experience leading a team of pharmacists managing prior authorizations
Must hold an active pharmacist license in the state of Missouri
Prior management experience (non-retail) is required
Experience with pharmacy claims, clinical operations (including prior authorizations), medication pricing methodologies, NCPDP standards, electronic prior authorizations, financial management, and managed care statutes (retail experience does not count)
Knowledge of current research and best practices related 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
This is a remote position within Missouri, with a preference for candidates located within 100 miles of Jefferson City, MO
Ability to travel to Jefferson City, MO on a monthly basis is required
Full-time, permanent, regular salaried (W-2) employee position

Responsibilities

Oversight of prior authorization, pharmacist appeals, and peer-to-peer DLP creation, modification, training, and implementation
Collaboration with internal leaders/teams including, but not limited to: Claims, Grievance and Appeals, Clinical, Quality Assurance, Network, and Training
Evaluate drug and drug class reviews following evidence-based research and processes widely accepted by the medical community
Maintain up-to-date knowledge of medications, drugs, and prescribing practices; advise Gainwell leaders based on your knowledge and expertise
Help write consultation and intervention scripts to support continuous improvement and quality improvement processes
Assist Gainwell clinical leadership in reviewing clinical criteria and Preferred Drug List (PDL) recommendations used to make coverage and PDL placement decisions