Prior Authorization Pharmacist - Oregon Medicaid; Remote

Prior Authorization Pharmacist - Oregon Medicaid (Remote)

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 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.
• Collaborate on the refinement of consultation scripting; solicit and utilize input from those contacted to improve scripting.
• Contribute 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.
• Serve as a resource for pharmacy-related questions and issues for others within the organization.
• Contribute to program improvements by using continuous quality improvement processes, proactively identifying opportunities, and providing ongoing consultation and collaboration with product leaders.
• Uphold clinical integrity of pharmaceutical solutions by staying up to date on medication information and clinical guidelines, contributing to the identification of pharmacy program best practices, and collaborating with Medical Directors and Clinical Pharmacists to provide pharmacy expertise.
• Collaborate internally with the 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.
• Perform other duties as assigned.
• Contribute creative solutions to improve operational efficiency and effectiveness of the pharmacy team.

Requirements

• PharmD or B.S. in Pharmacy.
• Registered Pharmacist with unrestricted state licensure from any state.
• Four years of experience in clinical pharmacy.
• Strong verbal and written communication skills.
• Highly skilled with Microsoft Office products and ability to quickly learn proprietary systems.
• Expected working hours: 9 a.m. to 5 p.m. Pacific Time, including select holidays and occasional weekend on-call coverage.

Basic Qualifications

• Experience in the coordination 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 is a plus.
• Strong research and implementation skills in practical settings.
• Analytical skills that translate into practical and pragmatic recommendations.
• Strong team orientation with respect for all members.
• Strong interpersonal skills that support successful consultation and collaboration with internal and external stakeholders who do not directly report to this role.
• Prior call center experience preferred.

Work Environment

• Work-from-home from any U.S. state.
• Travel approximately 0–10%.
• Reliable high-speed internet connectivity is required.
• A dedicated, private, distraction-free, HIPAA-compliant workspace with high-speed internet access is required.

We will accept applications until July 10, 2026. The pay range for this position is $85,000.00 - $ 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 '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.