Manager, Prior Authorizations (Pharmacist)

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

As a Prior Authorization Operations Manager (Licensed Pharmacist) at Gainwell, you can contribute your skills as we harness the power of technology to help our clients improve the health and well-being of the members they serve — a community’s most vulnerable. Connect your passion with purpose, teaming with people who thrive on finding innovative solutions to some of healthcare’s biggest challenges. Here are the details on this position. Your role in our mission Gainwell empowers you through innovative, purpose-built technologies and solutions to refine your skills and help deliver better health outcomes.

• Evaluate drug and drug class reviews following evidence-based research and processes widely accepted by the medical community
• Show your expertise by monitoring prescription claims data seen as exceptions to develop relevant retrospective drug utilization review (DUR) initiatives; present them to leadership
• Enhance your knowledge in this area by consulting physicians and prescribers identified as outliers, tracking contact attempts and documenting consultation results
• Help write consultation and intervention scripts to support continuous improvement and quality improvement processes
• Maintain up-to-date knowledge of medications, drugs and prescribing practices; advise Gainwell leaders based on your knowledge and expertise
• Assist Gainwell leadership in reviewing clinical criteria and Preferred Drug List (PDL) recommendations used to make coverage and PDL placement decisions

What We're Looking For

• Active, unrestricted pharmacist license required
• Five or more years of experience leading a team of pharmacists managing prior authorizations
• Applicant must be a licensed pharmacist
• Prior management experience required (retail management does not qualify)
• Experience with pharmacy claims, clinical operations (including prior authorizations), medication pricing methodologies, NCPDP standards, electronic prior authorizations, financial management, and managed-care regulations/statutes (retail experience does not count)
• Knowledge of current research and best practices related to specialty medications
• Analytical and research skills to conduct drug class and clinical reviews, including assessment of prescribing behavior and development of practical recommendations
• Strong written, oral, and clinical communication skills to collaborate with physicians, prescribers, pharmacists, and Gainwell leadership
• Demonstrated people-leadership skills with the ability to delegate effectively and support team success

What You Should Expect In This Role

• Work Arrangement: Remote within the United States
• Position Type: Full-time
• Travel: Approximately 10%

This position is for pipeline purposes, and we welcome applications on an ongoing basis. The pay range for this position is $130,000.00 - $170,000.00 per year, however, the base pay offered may vary depending on geographic region, internal equity, job-related knowledge, skills, and experience among other factors. Put your passion to work at Gainwell. You’ll have the opportunity to grow your career in a company that values work flexibility, learning, and career development. All salaried, full-time candidates are eligible for our generous, flexible vacation policy, a 401(k) employer match, comprehensive health benefits, and educational assistance. We also have a variety of leadership and technical development academies to help build your skills and capabilities. We believe nothing is impossible when you bring together people who care deeply about making healthcare work better for everyone. Build your career with Gainwell, an industry leader. You’ll be joining a company where collaboration, innovation, and inclusion fuel our growth. Learn more about Gainwell at our company website and visit our Careers site for all available job role openings. Gainwell Technologies is an Equal Opportunity Employer, where all qualified applicants will receive consideration for employment without regard to race, religion, color, national origin, gender (including pregnancy, childbirth, or related medical condition), age, sexual orientation, status as a protected veteran, status as an individual with a disability, or other applicable legally protected characteristics. Apply tot his job Apply To this Job