Prior Authorization 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

The Prior Authorization (PA) Pharmacist would facilitate efforts in the review of clinical documentation and the Preferred Drug list (PDL) to determine proper medication therapy. The PA pharmacist will work with internal and external stokeholds in evaluating and continually developing a strategy for Utilization Management 

Your role in our mission

• Clinical evaluation of medication therapy
• Review Prior Authorization request from medical professions using the PDL Criteria 
• Peer to Peer discussions with Medical providers to discuss Prior Authorization reviews.
• Consultations/Interventions:  work with Gainwell staff in contacting prescribers needing consultation to provide clinical information on prescribing practices that have been identified as outliers.  Reviews prior authorizations data and determine opportunities for interventions.
• Intervention Refinements:  Collaborates on the refinement of consultation scripting; solicits and utilizes input from those contacted toward scripting improvements.
• Operations:  Contributes to the success of the Clinical Call Centers and Prior Authorization department by assisting with the implementation and management of both written and verbal communications to members and physicians Is available for consultation on pharmacy-related questions and issues for others within the organization. 
• Quality Improvement:  Contributes to program improvements by using continuous quality improvement processes, by being proactive in identifying improvement opportunities and by contributing on-going consultation and collaboration with product leaders.
• Medical/Clinical:  Upholds clinical integrity of pharmaceutical solutions by staying up to date on medication information, contributing to the identification of pharmacy program best practices, collaborating with Medical Directors, Clinical Pharmacist, and Clinical Specialty Pharmacist to provide pharmacy expertise.
• Other duties as assigned.  Contributes creative solutions to improve operational efficiency and effectiveness of pharmacy team.

What we're looking for

• 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.

What you should expect in this role

• Remote within the United States.
• Schedule may vary based on business needs. Candidates should be flexible and available to work evenings, weekends, or holidays as needed.

The application period closes on November 6, 2026.

The pay range for this position is $90,900.00 - $129,900.00 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. Gainwell Technologies defines “wages” and “wage rates” to include “all forms of pay, including, but not limited to, salary, overtime pay, bonuses, stock, stock options, profit sharing and bonus plans, life insurance, vacation and holiday pay, cleaning or gasoline allowances, hotel accommodations, reimbursement for travel expenses, and benefits.

Originally posted on Himalayas