Summary
The Prior Authorization (PA) Pharmacist is responsible for reviewing prior authorization requests from providers to ensure safe and effective medication utilization. The PA pharmacist will work with internal and external stakeholders in evaluating and continually developing a strategy for Utilization Management.
Essential Job Functions
• Review Prior Authorization requests from medical professionals to ensure alignment with Preferred Drug List (PDL) criteria and current clinical guidelines
• Support Peer to Peer discussions with medical providers to discuss Prior Authorization reviews
• Collaborates on the refinement of consultation scripting; solicits and utilizes input from those contacted toward scripting improvements
• 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
• Contributes to program improvements by using continuous quality improvement processes, by being proactive in identifying opportunities and by contributing on-going consultation and collaboration with product leaders
• Upholds clinical integrity of pharmaceutical solutions by staying up to date on medication information, clinical guidelines, contributing to the identification of pharmacy program best practices, and collaborating with Medical Directors, Clinical Pharmacist, and Clinical Pharmacist to provide pharmacy expertise
• Collaborate internally with pharmacy team (Pharmacy Manager, Clinical Pharmacists) to identify trends or areas to explore with the intent of identifying new drugs and therapeutic classes needing utilization management
• Other duties as assigned
• Contributes creative solutions to improve operational efficiency and effectiveness of pharmacy team
Basic Qualifications
• Experience in the coordination of and collaboration of work teams preferred
• Ability to perform clinical reviews using relevant compendia and clinical trial data
• Managed care and/or prior authorization experience a plus
• Strong research and implementation skills in practical settings
• Analytical skills which can translate into practical and pragmatic recommendations
• Strong team orientation with respect for all members.
• People skills are essential that allow for successful consultation and collaboration with internal and external stakeholders who do not directly report to this job.
• Prior call center experience preferred
Requirements
• PharmD or B.S. in Pharmacy with relevant Specialty background
• Registered Pharmacist with unrestricted respective State Licensure (Wisconsin Pharmacist License Preferred but not required)
• 4 years' experience in clinical pharmacy
• Strong verbal and written communications skills
• Highly skilled with Microsoft Office products and ability to quickly learn proprietary systems
Short Description
• Remote within the US
• No Travel Required
• Expected Working Hours: 9 am to 5 pm Central Time including select holidays and occasional weekend on call coverage
Applications will be accepted through June 22, 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.
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