Prior Authorization Pharmacist - Wisconsin Medicaid (Remote)

Gainwell Technologies LLC•Any city, OH

2d•$90,900 - $129,900•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 with relevant Specialty background
Registered Pharmacist with unrestricted respective State Licensure (Wisconsin Pharmacist License Preferred but not required)
4 years’ experience in clinical pharmacy
Strong verbal and written communications skills
Highly skilled with Microsoft Office products and ability to quickly learn proprietary systems

Nice To Haves

Experience in the coordination of 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 a plus
Strong research and implementation skills in practical settings
Analytical skills which can translate into practical and pragmatic recommendations
Strong team orientation with respect for all members.
People skills are essential that allow for successful consultation and collaboration with internal and external stakeholders who do not directly report to this job.
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
Collaborates on the refinement of consultation scripting; solicits and utilizes input from those contacted toward scripting improvements
Contributes 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.
Is available for consultation on pharmacy-related questions and issues for others within the organization
Contributes to program improvements by using continuous quality improvement processes, by being proactive in identifying opportunities and by contributing on-going consultation and collaboration with product leaders
Upholds clinical integrity of pharmaceutical solutions by staying up to date on medication information, clinical guidelines, contributing to the identification of pharmacy program best practices, and collaborating with Medical Directors, Clinical Pharmacist, and Clinical Pharmacist to provide pharmacy expertise
Collaborate internally with 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
Other duties as assigned
Contributes creative solutions to improve operational efficiency and effectiveness of pharmacy team