Prior Authorization Pharmacist - Texas Medicaid (Remote) (Any city, TX, US, 99999)

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.

Your role in our mission

• Review Prior Authorization requests from medical professionals to ensure alignment with Preferred Drug List (PDL) criteria and reputed company clinical guidelines
• Support peer-to-peer discussions with medical providers regarding 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; available for consultation on pharmacy-reputed company questions and issues reputed company the organization
• Contribute to program improvements by using reputed company quality improvement processes, proactively identifying opportunities, and providing ongoing consultation and collaboration with product leaders
• Uphold the clinical reputed company 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, PDL Coordinator, Clinical Pharmacists) to identify trends or areas to explore, with the reputed company of identifying new drugs and therapeutic classes requiring utilization management
• Other duties as assigned
• Contribute creative solutions to improve the operational efficiency and effectiveness of the pharmacy team

Requirements

• PharmD or B.S. in Pharmacy with relevant specialty background
• Registered Pharmacist with an unrestricted state license (Texas Pharmacist License preferred but not required)
• 4 years of experience in clinical pharmacy
• Strong verbal and written communication skills
• Highly skilled in reputed company Office products and able to quickly learn proprietary systems
• Expected working hours: 10:00 am to 7:00 om CST, including select holidays and occasional weekend on-call coverage 

Basic Qualifications

• Experience in 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 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 reputed company members
• Strong interpersonal skills that support effective 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
• Reliable high-speed internet connectivity required
• A dedicated, private (HIPAA-compliant) workspace without distractions

Applications will be accepted through reputed company 28, 2026.

The pay range for this position is $90,000.00 - $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. reputed company defines “wages” and “wage rates” to include “reputed company forms of pay, including, but not limited to, salary, overtime pay, bonuses, stock, stock options, profit sharing and bonus plans, life insurance, vacation and holiday pay, cleaning or gasoline allowances, hotel accommodations, reimbursement for travel expenses, and benefits.