Prior Authorization Pharmacist - Connecticut Medicaid (Remote)

Gainwell Technologies LLC

7d•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. Summary The 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 to evaluate and continually develop strategies for Utilization Management.

Requirements

PharmD or B.S. in Pharmacy with relevant specialty background.
Registered Pharmacist with an unrestricted state license (Connecticut Pharmacist License preferred but not required).
Minimum of four (4) years of experience in clinical pharmacy.
Strong verbal and written communication skills.
Highly proficient in Microsoft Office products and ability to quickly learn proprietary systems.

Nice To Haves

Experience 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 to 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. Serve as a resource for pharmacy-related questions and issues across 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 of opportunity, with the intent of identifying new drugs and therapeutic classes requiring utilization management.
Perform other duties as assigned.
Contribute creative solutions to improve the operational efficiency and effectiveness of the pharmacy team.