Prior Authorization Pharmacist - Oregon Medicaid (Remote)

Gainwell Technologies LLC•Any city, OH

4d•$85,000 - $121,400•Remote

About The Position

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 in evaluating and continually developing a strategy for Utilization Management. This role offers flexible hours and opportunities for career growth in a company that values work-life balance, continuous learning, and career development.

Requirements

PharmD or B.S. in Pharmacy.
Registered Pharmacist with unrestricted state licensure from any state.
Four years of experience in clinical pharmacy.
Strong verbal and written communication skills.
Highly skilled with Microsoft Office products and ability to quickly learn proprietary systems.
Expected working hours: 9 a.m. to 5 p.m. Pacific Time, including select holidays and occasional weekend on‑call coverage.

Nice To Haves

Experience in the coordination and collaboration of 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 successful 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 to discuss 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 for others 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 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, Clinical Pharmacists) to identify trends or areas to explore, with the intent of identifying new drugs and therapeutic classes needing utilization management.
Perform other duties as assigned.
Contribute creative solutions to improve operational efficiency and effectiveness of the pharmacy team.