Manager, Prior Authorizations (Pharmacist)

Summary

As a Prior Authorization Operations Manager (Licensed Pharmacist) at Gainwell, you can contribute your skills as we harness the power of technology to help our clients improve the health and well-being of the members they serve — a community’s most vulnerable. Connect your passion with purpose, teaming with people who thrive on finding innovative solutions to some of healthcare’s biggest challenges. Here are the details on this position.

Your role in our mission

• Gainwell empowers you through innovative, purpose-built technologies and solutions to refine your skills and help deliver better health outcomes.
• Oversight of prior authorization, pharmacist appeal 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

What we're looking for

• 5 or more years experience leading a team of pharmacists that are managing prior authorizations
• Applicant must be a licensed pharmacist
• Prior management experience not including retail experience is required
• Experience with pharmacy claims, clinical operations (including prior authorizations) medication pricing methodologies, NCPDP standards, electronic prior authorizations, financial management and managed care statute. Retail does not count.
• Knowledge of current research and best practices relating to specialty medications
• Analytical and research expertise to conduct drug class and clinical reviews involving prescribing behavior to reach pragmatic conclusions
• 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 

What you should expect in this role

• This is a full-time permanent regular salaried (W-2) employee position.
  • Monday through Friday work schedule (40 hours per week).
• Upward career advancement is possible and encouraged.
• Health (medical, dental, vision) and paid time off benefits start on day 1 of employment.
• Company match 401K and other benefits available within months of starting.
• Employees are eligible to take advantage of flexible vacation policy after ninety (90) calendar days of employment. Any exception requires manager approval prior to employee's Gainwell start date.
• Company provided computer for work use.
• For all hybrid and remote positions employees' Broadband Internet connections, should have a minimum speed of 24MBS download and 8 MBS upload.  Greater speeds will of course provide better performance.
  • To Test your internet download and upload speed:
    • Go to Google.
    • Search for Internet Speed Test  
• Video cameras must be used during all interviews, as well as during the initial week of orientation if hired.
• Please attach a resume to your candidate profile written in English.
• Must be willing to travel to Dublin, OH at least once per month.
• Applications will be taken on an ongoing basis until a candidate is selected. Our target date to stop taking applications is 2/17/2025.

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