Prior Authorization Pharmacist - Oregon Medicaid (Remote)

Gainwell Technologies LLC•Any city, OH

3d•$90,900 - $129,900•Remote

About The Position

The Prior Authorization Pharmacist reviews provider prior authorization requests to support safe and effective medication utilization. The role evaluates requests against Preferred Drug List criteria and current clinical guidelines, supports peer-to-peer discussions with providers, and collaborates with internal and external stakeholders to evaluate and develop Utilization Management strategy. The pharmacist also helps improve communications, clinical integrity, and operational effectiveness across the Clinical Call Centers and Prior Authorization department. This position is remote in the United States. The work environment requires a dedicated, private, distraction-free, HIPAA-compliant home office and reliable high-speed internet. The schedule is 9:00 AM–5:00 PM Pacific Time, with select holidays and occasional weekend on-call support. Applications will be accepted until October 30, 2026.

Requirements

PharmD or Bachelor of Science in Pharmacy.
Registered Pharmacist with unrestricted licensure in the applicable state.
Four years of experience in clinical pharmacy.
Strong verbal and written communication skills.
High proficiency with Microsoft Office products and ability to learn proprietary systems quickly.
Ability to perform clinical reviews using relevant compendia and clinical trial data.
Strong research and implementation skills in practical settings.
Analytical skills that support practical, pragmatic recommendations.
Strong team orientation and respect for all team members.
People skills that enable effective consultation and collaboration with internal and external stakeholders who do not report directly to this position.

Nice To Haves

Experience coordinating and collaborating with work teams.
Managed care and/or prior authorization experience.
Prior call center experience.

Responsibilities

Review prior authorization requests from medical professionals for alignment with Preferred Drug List criteria and current clinical guidelines.
Support peer-to-peer discussions with medical providers concerning prior authorization reviews.
Collaborate on refining consultation scripts and use feedback from people contacted to improve them.
Assist with implementation and management of written and verbal communications to members and physicians for the Clinical Call Centers and Prior Authorization department.
Provide consultation on pharmacy-related questions and issues to others within the organization.
Contribute to program improvements through continuous quality improvement, identifying opportunities, and ongoing consultation and collaboration with product leaders.
Maintain the clinical integrity of pharmaceutical solutions by staying current on medication information and clinical guidelines, identifying pharmacy program best practices, and collaborating with Medical Directors and Clinical Pharmacists.
Work with the pharmacy team, including the Pharmacy Manager and Clinical Pharmacists, to identify trends and areas for exploration, including drugs and therapeutic classes that may need utilization management.
Contribute creative solutions to improve the operational efficiency and effectiveness of the pharmacy team.
Perform other duties as assigned.