Prior Authorization Pharmacist

🔥 17 hours ago

🌲 North Carolina – Remote

🌲 North Carolina – Remote

💵 $90.9k - $129.9k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

💊 Pharmacist

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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

• Facilitate review of clinical documentation and the Preferred Drug List to determine proper medication therapy • Review Prior Authorization requests from medical professionals using Preferred Drug List criteria • Conduct peer-to-peer discussions with medical providers regarding Prior Authorization reviews • Contact prescribers for consultation and provide clinical information on prescribing practices identified as outliers • Review Prior Authorization data and determine opportunities for interventions • Collaborate on refinement of consultation scripting and use feedback to improve scripts • Assist with implementation and management of written and verbal communications to members and physicians • Provide consultation on pharmacy-related questions and issues within the organization • Contribute to continuous quality improvement and identify improvement opportunities • Collaborate with product leaders, Medical Directors, Clinical Pharmacists, and Clinical Specialty Pharmacists • Stay current on medication information and contribute to pharmacy program best practices • Contribute creative solutions to improve pharmacy team operational efficiency and effectiveness • Perform other duties as assigned

🎯 Requirements

• PharmD or B.S. in Pharmacy with relevant specialty experience • Registered Pharmacist with active state licensure • Four years of experience in clinical pharmacy • Experience coordinating and collaborating with work teams preferred • Ability to perform clinical reviews using relevant compendia and clinical trial data • Managed care pharmaceutical services experience is a plus • Strong research and implementation skills in practical settings • Analytical skills with the ability to translate findings into practical and pragmatic recommendations • Strong team orientation and respect for all team members • Excellent interpersonal skills, with the ability to successfully 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 the ability to quickly learn proprietary systems • Must be available to work evenings, weekends, or holidays as needed • Role is remote within the United States

🏖️ Benefits

• Flexible hours • Work-life balance • Continuous learning and career development • Flexible vacation policy • 401(k) employer match • Comprehensive health benefits • Educational assistance • Leadership and technical development academies