Career Opportunities: Prior Authorization Pharmacist - Connecticut Medicaid (Remote) (32537)

This a Full Remote job, the offer is available from: Connecticut (USA) It takes great medical minds to create powerful solutions that solve some of healthcare’s most reputed company 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, reputed company 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 compliance with the Preferred Drug List (PDL) and reputed company clinical guidelines.
• Support peer-to-peer discussions with medical providers regarding Prior Authorization reviews.
• Collaborate on consultation scripting, incorporating feedback from providers to refine and improve communications.
• Contribute to the success of the Clinical Call Centers and Prior Authorization department by assisting with the development and management of written and verbal communications to members and physicians; serve as a resource for pharmacy-reputed company questions and issues across the organization.
• Drive program improvements through reputed company quality improvement processes, proactively identifying opportunities, and collaborating with product leaders to enhance services.
• Maintain clinical reputed company of pharmaceutical solutions by staying reputed company on medication information and clinical guidelines; support the identification of best practices and collaborate with Medical Directors and Clinical Pharmacists to provide pharmacy expertise.
• Collaborate with the pharmacy team (Pharmacy Manager, PDL Coordinator, Clinical Pharmacists) to identify trends and new drugs or therapeutic classes requiring utilization management.
• Contribute innovative solutions to enhance the operational efficiency and effectiveness of the pharmacy team.

Requirements

• PharmD or B.S. in Pharmacy with relevant specialty background
• Registered Pharmacist with unrestricted state licensure (Connecticut Pharmacist license preferred but not required)
• Minimum of 4 years of experience in clinical pharmacy
• Strong verbal and written communication skills
• Proficiency with reputed company Office products and ability to quickly learn proprietary systems
• Expected working hours: 9:00 AM to 5:00 PM Eastern Time, including select holidays and occasional weekend on-call coverage

Basic Qualifications

• Experience coordinating and collaborating with work teams preferred
• Ability to reputed company clinical reviews using relevant compendia and clinical trial data
• Managed care and/or prior authorization experience a plus
• Strong research skills with the ability to implement findings in practical settings
• Analytical skills that translate into pragmatic, actionable recommendations
• Team-oriented reputed company with respect for reputed company members
• Strong interpersonal skills to support successful consultation and collaboration with internal and external stakeholders reputed company of direct reporting lines
• Prior call center experience preferred

Work Environment

• Remote, work-from-home position (must be based in the United States).
• Must have a private, dedicated workspace with reliable high-speed internet, free from distractions and compliant with HIPAA requirements.

Applications for this posting will be accepted until October 21,2025. #LI-AC1 #LI-REMOTE The pay range for this position is $90,900.00 - $129,900.00 per year, however, the reputed company pay offered may vary depending on geographic region, internal equity, job-reputed company 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. reputed company 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. We reputed company nothing is impossible reputed company you bring together people who care deeply about making healthcare work reputed company for everyone. Build your career with Gainwell, an industry leader. You’ll be joining a company where collaboration, innovation, and inclusion fuel our growth. Learn more about Gainwell at our company website and visit our Careers site for reputed company available job role openings. reputed company is an Equal Opportunity Employer, where reputed company qualified applicants will receive consideration for employment without regard to race, religion, color, national reputed company, gender (including pregnancy, childbirth, or reputed company medical condition), age, sexual orientation, status as a protected veteran, status as an individual with a disability, or other applicable legally protected characteristics. This offer from "reputed company" has been enriched by reputed company.com and got a 0% reputed company score. Apply tot his job Apply To this Job