Prior Authorization Pharmacist – Oregon Medicaid

🔥 2 hours ago

🌲 Oregon – Remote

🌲 Oregon – Remote

💵 $90.9k - $129.9k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

💊 Pharmacist

🦅 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

• Operate the Medicaid prescription drug program within state budget and legislative requirements • Review prior authorization requests for alignment with Preferred Drug List criteria and clinical guidelines • Support peer-to-peer consultations with providers for timely authorization decisions • Conduct clinical evaluations of medication therapy using relevant compendia and clinical trial data • Contact prescribers for consultations and interventions regarding identified prescribing outliers • Review prior authorization data and identify intervention opportunities • Support written and verbal communications with members and physicians • Provide clinical input to call center agents handling provider and pharmacy calls • Contribute to continuous quality improvement and process enhancements • Collaborate with Medical Directors, Clinical Pharmacists, Clinical Specialty Pharmacists, product leaders, and pharmacy teams • Serve as a subject matter expert for pharmacy-related questions • Provide clinical input during weekly drug file updates and recommend utilization controls • Support Medicaid Drug Rebate Program operations • Assist the state with pharmacy audits using system claim details • Provide ongoing training to pharmacy providers • Produce annual reports and perform executive administrative duties for the state pharmacy program

🎯 Requirements

• Ability to communicate succinctly and accurately in both written and verbal English • Ability to perform clinical reviews using relevant compendia and clinical trial data • Managed care pharmaceutical service experience a plus • Strong research and implementation skills in practical settings • Analytical skills that translate into practical and pragmatic recommendations • Strong team orientation and respect for all members • Consultation and collaboration skills with internal and external stakeholders • Excellent organizational, written, and oral communication skills • Maintain confidentiality and comply with HIPAA • Highly skilled with Microsoft Office products and able to quickly learn proprietary systems • Proficient with work organization and problem resolution skills • Pharmacist expertise and clinical medication therapy evaluation knowledge • Experience reviewing prior authorization requests using Preferred Drug List criteria

🏖️ 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