Senior Manager, Prior Authorizations – Pharmacist

🕒 April 9

🏰 Missouri – Remote

🏰 Missouri – Remote

💵 $122.2k - $174.6k / year

⏰ Full Time

🟠 Senior

👔 Manager

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Gainwell Technologies

WebsiteLinkedInAll Job Openings

10,000+ employees

⚕️ Healthcare Insurance

💰 Grant on 2023-06

Healthcare Insurance • Human Services • Healthcare

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

• Oversight of prior authorization, pharmacist appeals, and peer-to-peer DLP creation, modification, training, and implementation • Collaboration with internal leaders/teams including, but not limited to: Claims, Grievance and Appeals, Clinical, Quality Assurance, Network, and Training • Evaluate drug and drug class reviews following evidence-based research and processes widely accepted by the medical community • Maintain up-to-date knowledge of medications, drugs, and prescribing practices; advise Gainwell leaders based on your knowledge and expertise • Help write consultation and intervention scripts to support continuous improvement and quality improvement processes • Assist Gainwell clinical leadership in reviewing clinical criteria and Preferred Drug List (PDL) recommendations used to make coverage and PDL placement decisions

🎯 Requirements

• 5 or more years of experience leading a team of pharmacists managing prior authorizations • Must hold an active pharmacist license in the state of Missouri • Prior management experience (non-retail) is required • Experience with pharmacy claims, clinical operations, medication pricing methodologies, NCPDP standards, electronic prior authorizations, financial management, and managed care statutes • Knowledge of current research and best practices related to specialty medications • Analytical and research expertise to conduct drug class and clinical reviews involving prescribing behavior • Strong written, oral, and clinical communication skills to collaborate with physicians, prescribers, pharmacists, and Gainwell leadership • A caring people leader who understands their role on a team and can effectively delegate tasks

🏖️ Benefits

• Comprehensive health benefits • 401(k) employer match • Flexible vacation policy • Educational assistance • Leadership and technical development academies