Medical Reviewer, Pharmacist

🔥 0 minutes ago

🏄 California – Remote

🏄 California – Remote

💵 $100k - $140k / year

⏰ Full Time

🟢 Junior

🔍🏥 Medical Reviewer

🦅 H1B Visa Sponsor

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Gainwell Technologies

WebsiteLinkedInAll Job Openings

10,000+ employees

💼 Consulting

📦 Logistics

⚕️ Healthcare Insurance

💰 Grant on 2023-06

Consulting • Logistics • Healthcare Insurance

Gainwell Technologies is the nation’s leading provider of digital and cloud-enabled solutions across the human services and public health ecosystem. With a mission-driven approach, Gainwell serves clients in all 50 U. S. states, focusing on improving health outcomes and delivering intuitive, human-centered experiences. Their comprehensive suite of solutions includes Medicaid Enterprise modernization, data analytics, provider services, and pharmacy solutions, all designed to advance the future of healthcare and enhance community well-being.

📋 Description

• Perform pharmacy and medication-related clinical reviews • Support pharmacy claim review and adjudication activities • Provide clinical expertise for drug utilization review and drug-related authorization requests • Support drug rebate and pharmacy program activities as assigned • Review pharmacy documentation for compliance with applicable policies and coverage requirements • Provide technical expertise and assistance related to pharmacy review • Document findings and recommendations accurately and timely • Collaborate with physicians, nurses, pharmacy teams, operations, and other healthcare professionals • Maintain knowledge of applicable pharmacy policies and regulatory requirements • Work primarily from a home office while supporting Medical Review Services for California healthcare programs • Review pharmacy, clinical, claim, authorization, and supporting documentation • Navigate multiple computer systems and applications to complete reviews and document findings • Meet established quality, accuracy, productivity, and turnaround-time expectations

🎯 Requirements

• Current, non-expired pharmacist license from the State of California, in good standing • Must not be under suspension from Medicare, Medicaid, or pharmacy practice in California • Must not have been previously sanctioned for fraud or abuse • Three (3) years of previous experience as a pharmacy consultant for a government or private-sector healthcare payer; or one (1) year of MMIS experience in a large state providing technical expertise and assistance for pharmacy review • Strong oral and written communication skills • Strong knowledge of pharmacy practices, medication review, and healthcare reimbursement processes • Maintain all professional licenses, certifications, and credentials required for the position in active, unrestricted, and good-standing status • Travel requirement: 0-10%

🏖️ Benefits

• Flexible vacation policy • 401(k) employer match • Comprehensive health benefits • Educational assistance • Leadership and technical development academies • Flexible work hours • Remote work environment • Ongoing training and support • Work-life balance • Career development opportunities