Prior Authorization Pharmacist - Texas Medicaid (Remote)

Gainwell Technologies LLC

2d•$90,000 - $129,900•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. SummaryThe Prior Authorization (PA) Pharmacist is responsible for reviewing prior authorization requests from providers to ensure safe and effective medication utilization. The PA pharmacist will work with internal and external stakeholders in evaluating and continually developing a strategy for Utilization Management.Your role in our mission

Requirements

PharmD or B.S. in Pharmacy with relevant specialty background
Registered Pharmacist with an unrestricted state license (Texas Pharmacist License preferred but not required)
4 years of experience in clinical pharmacy
Strong verbal and written communication skills
Highly skilled in Microsoft Office products and able to quickly learn proprietary systems
Expected working hours: 10:00 am to 7:00 om CST, including select holidays and occasional weekend on-call coverage

Nice To Haves

Experience in coordinating and collaborating with work teams preferred
Ability to perform clinical reviews using relevant compendia and clinical trial data
Managed care and/or prior authorization experience is a plus
Strong research and implementation skills in practical settings
Analytical skills that translate into practical and pragmatic recommendations
Strong team orientation with respect for all members
Strong interpersonal skills that support effective consultation and collaboration with internal and external stakeholders who do not directly report to this role
Prior call center experience preferred

Responsibilities

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 regarding Prior Authorization reviews
Collaborate on the refinement of consultation scripting; solicit and utilize input from those contacted to improve scripting
Contribute 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; available for consultation on pharmacy-related questions and issues within the organization
Contribute to program improvements by using continuous quality improvement processes, proactively identifying opportunities, and providing ongoing consultation and collaboration with product leaders
Uphold the clinical integrity of pharmaceutical solutions by staying up to date on medication information and clinical guidelines, contributing to the identification of pharmacy program best practices, and collaborating with Medical Directors and Clinical Pharmacists to provide pharmacy expertise
Collaborate internally with the pharmacy team (Pharmacy Manager, PDL Coordinator, Clinical Pharmacists) to identify trends or areas to explore, with the intent of identifying new drugs and therapeutic classes requiring utilization management
Other duties as assigned
Contribute creative solutions to improve the operational efficiency and effectiveness of the pharmacy team