It takes great medical minds to create powerful solutions that solve some of healthcare’s most complex challenges. 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. The Prior Authorization (PA) Pharmacist is responsible for reviewing prior authorization requests from providers to ensure safe and effective medication utilization. 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 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 Contributes creative solutions to improve operational efficiency and effectiveness of pharmacy team S. in Pharmacy
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