Professional Quality - PBM Technician

Summary

As a Professional Quality - PBM Technician 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

• Conducts assessments and evaluations of prior authorization through analysis and interpretation of objective and subjective evidence to verify compliance to the established standards, policies and procedures, best practices and/or applicable quality plan.

• Develops and maintains quality assurance documentation for projects and tasks to include quality metrics. Assists in the development and maintenance of written reports of audits; escalates unresolved issues or findings to appropriate level.

• Evaluates work products to independently assess quality and reports findings. Researches alternative solutions to problems, determines proper approaches and makes verbal and/or written recommendations to appropriate parties. Assists in implementing recommendations as approved.
• Participates in special projects, external audits and process improvements in support of quality assurance initiatives.

What we're looking for

• At least 3 years of experience as a pharmacy technician in retail, hospital, managed care, insurance, or pharmacy benefits manager (PBM)
• Experience working with standard software including proficiency in Microsoft Office, Outlook, and Teams.
• Experience working with quality assurance and quality metrics and software industry metric data collection and analysis techniques is recommended but not required.
• Experience working within the Medicaid/Medicare pharmacy benefits manager sector is recommended but not required.

Other Qualifications

• Good organization and time management skills.
• Strong communication skills to interact and present findings to team members, management and support personnel.
• Good analytical and problem solving skills.
• Good interpersonal skills for interacting with project and task team members.
• Collaborative culture where innovation and suggestions for process improvements are welcomed.

What you should expect in this role

• Remote position 
• Opportunities to travel through your work (0-10%)
• Video cameras must be used during all interviews, as well as during the initial week of orientation
• The deadline to submit applications for this posting is 10/24/2025

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