[Hiring] Prior Authorization Pharmacist @Gainwell Technologies LLC

Role Description

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.

• 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 toward scripting improvements.
• 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.
• Be available for consultation on pharmacy-related questions and issues for others within the organization.
• Contribute to program improvements by using continuous quality improvement processes, proactively identifying opportunities, and collaborating with product leaders.
• Uphold clinical integrity of pharmaceutical solutions by staying up to date on medication information and clinical guidelines.
• 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.
• Contribute creative solutions to improve operational efficiency and effectiveness of pharmacy team.
• Other duties as assigned.

Qualifications

• PharmD or B.S. in Pharmacy.
• Registered Pharmacist with unrestricted respective State Licensure.
• 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.
• 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 for successful consultation and collaboration with internal and external stakeholders.
• Prior call center experience preferred.

Requirements

• Location: Remote, United States.
• Work Environment: Dedicated, private home office that is HIPAA compliant and free from distractions.
• Schedule: 9:00 AM - 5:00 PM PT, including select holidays and occasional weekend on-call support.
• Technology Requirements: Reliable high-speed internet connection required.

Benefits

• Generous, flexible vacation policy.
• 401(k) employer match.
• Comprehensive health benefits.
• Educational assistance.
• Leadership and technical development academies to help build your skills and capabilities.