Director of PBM Prior Authorization Operations - Remote US

Date: Oct 28, 2025

Location:

Any city, OH, US, 99999

Req ID: 33458

Work Mode: Virtual (Exception only)

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

Join Gainwell Technologies and lead innovative, high-performing pharmacy operations that improve access to care and drive measurable outcomes. As Director of PBM Prior Authorization Operations, you will oversee large-scale teams responsible for clinical review, prior authorization, and utilization management programs that directly impact the member and client experience. This position offers the opportunity to shape national pharmacy benefit operations and support Gainwell’s mission of delivering better health and human services outcomes.

Your role in our mission

Lead a nationwide team of pharmacists, pharmacy technicians, and operations managers responsible for prior authorization and utilization management programs.
Oversee clinical review workflows, formulary and PDL adherence, and performance outcomes across multiple PBM clients.
Serve as the strategic operations lead and clinical subject matter expert for all utilization management programs.
Partner with client leadership to ensure service excellence, compliance, and alignment with contractual obligations.
Implement data-driven strategies to enhance efficiency, quality, and member outcomes across all pharmacy operations.
Forecast, budget, and manage staffing for a scalable, high-volume team to meet seasonal and client demands.

What we're looking for

Licensed Pharmacist (PharmD or RPh) in good standing; licensure in any U.S. state accepted.
Minimum 5 years of experience leading prior authorization or utilization management teams within a PBM or managed care setting.
Proven success managing large-scale teams (100+ FTEs) and developing mid-level and frontline leaders.
Demonstrated ability to improve key operational metrics such as turnaround time, accuracy, and customer satisfaction.
Strong understanding of Medicaid and PDL management processes and compliance standards.
Exceptional leadership, communication, and analytical skills with the ability to thrive in a fast-paced environment.

What you should expect in this role

Remote, full-time position with national scope and cross-functional collaboration.
Comprehensive benefits package including medical, dental, vision, 401(k), and paid time off.
Nine paid holidays and three floating holidays annually.
Reliable broadband internet connection required (minimum 24 Mbps download / 8 Mbps upload).
Opportunity to lead a mission-driven organization transforming healthcare operations through innovation and excellence.
Collaborative culture that values diversity, teamwork, and continuous improvement.

This posting is intended for pipelining. We will accept applications on an ongoing basis.

The pay range for this position is $130,000 - $200,000 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.