Prior Authorization Pharmacist- Remote

Gainwell Technologies LLC•Any city, OH

2d•$90,900 - $129,900•Remote

About The Position

The Prior Authorization Pharmacist reviews clinical documentation and Preferred Drug List (PDL) criteria to evaluate medication therapy and prior authorization requests. The role supports the development and ongoing refinement of Utilization Management strategies, working with internal and external stakeholders. The pharmacist conducts peer-to-peer discussions with medical providers, consults with prescribers about prescribing practices identified as outliers, reviews prior authorization data to identify intervention opportunities, and helps improve consultation scripts. The role also supports Clinical Call Center and Prior Authorization operations, responds to pharmacy-related questions, contributes to quality improvement, and collaborates with medical and clinical colleagues to maintain the clinical integrity of pharmacy solutions. This is a remote position within the United States. The schedule may vary based on business needs, and the successful candidate should be flexible and available to work evenings, weekends, or holidays as needed.

Requirements

PharmD or B.S. in Pharmacy with relevant specialty experience.
Active state pharmacist licensure.
Four years of experience in clinical pharmacy.
Ability to perform clinical reviews using relevant compendia and clinical trial data.
Strong research and implementation skills in practical settings.
Analytical skills and the ability to translate findings into practical recommendations.
Strong team orientation and respect for all team members.
Excellent interpersonal skills and the ability to consult and collaborate with internal and external stakeholders who do not directly report to this role.
Strong verbal and written communication skills.
Proficiency with Microsoft Office products and ability to quickly learn proprietary systems.

Nice To Haves

Experience coordinating and collaborating with work teams.
Managed care pharmaceutical services experience.

Responsibilities

Review clinical documentation and Preferred Drug List (PDL) criteria to evaluate medication therapy and prior authorization requests.
Conduct peer-to-peer discussions with medical providers regarding prior authorization reviews.
Contact prescribers for consultations and provide clinical information about prescribing practices identified as outliers.
Review prior authorization data and identify opportunities for interventions.
Collaborate on consultation script refinements and use feedback from those contacted to improve scripts.
Support the Clinical Call Centers and Prior Authorization department with written and verbal communications to members and physicians.
Provide consultation on pharmacy-related questions and issues for others within the organization.
Contribute to program improvements through continuous quality improvement, identifying opportunities, and collaborating with product leaders.
Stay current on medication information and help identify pharmacy program best practices.
Collaborate with Medical Directors, Clinical Pharmacists, and Clinical Specialty Pharmacists to provide pharmacy expertise.
Contribute creative solutions to improve pharmacy team efficiency and effectiveness.
Perform other duties as assigned.