Gainwell Technologies

Prior Authorization Pharmacist - Texas Medicaid

Gainwell Technologies  •  Texas (Onsite)  •  4 hours ago
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Job Description

As ​ Prior Authorization Pharmacist - Texas Medicaid at Gainwell, you can contribute your skills as we harness the power of technology to help our clients improve the health and well-being of the members they serve — a community’s most vulnerable. Connect your passion with purpose, teaming with people who thrive on finding innovative solutions to some of healthcare’s biggest challenges. Here are the details on this position.

Your role in our mission

Gainwell empowers you through innovative, purpose-built technologies and solutions to refine your skills and help deliver better health outcomes.

  • Evaluate drug and drug class reviews following evidence-based research and processes widely accepted by the medical community
  • Show your expertise by monitoring prescription claims data seen as exceptions to develop relevant retrospective drug utilization review (DUR) initiatives; present them to leadership
  • Enhance your knowledge in this area by consulting physicians and prescribers identified as outliers, tracking contact attempts and documenting consultation results
  • Help write consultation and intervention scripts to support continuous improvement and quality improvement processes
  • Maintain up-to-date knowledge of medications, drugs and prescribing practices; advise Gainwell leaders based on your knowledge and expertise
  • Assist Gainwell leadership in reviewing clinical criteria and Preferred Drug List (PDL) recommendations used to make coverage and PDL placement decisions

What we're looking for

  • 5 or more years of experience in a clinical pharmacy setting, with managed care pharmaceutical service experience a plus
  • Knowledge of current research and best practices relating to specialty medications
  • Analytical and research expertise to conduct drug class and clinical reviews involving prescribing behavior to reach pragmatic conclusions
  • Strong written, oral and clinical communication skills to collaborate with physicians, prescribers, pharmacists and Gainwell leadership
  • A caring people leader who understands their role on a team and can effectively delegate tasks

What you should expect in this role

  • Opportunities to travel through your work (0-10%)
Gainwell Technologies

About Gainwell Technologies

For 50 years, our nation’s federal Medicaid program has worked to improve the health, safety and well-being of America’s most vulnerable populations: low-income families, women and children, seniors, and those with disabilities. With positive health and cost outcomes that pierce inequities and impact economies, the success of these programs is inextricably tied to the prosperity of communities, individual states and the nation as a whole. We think that demands respect and, more importantly, is deserving of a lifetime commitment from innovators who can help those who operate within and around health and human services evolve — in any market at any stage. At Gainwell Technologies, that’s our sole focus.

Built across more than five decades, Gainwell has intentionally seized opportunities to advance its digitally enabled services to meet agencies, health plans and MCOs where they are on their modernization journeys and propel them into the future of public health. Our commitment to innovation, deep experience and ability to leverage insights from customers across 50 states has allowed us to expand on next-generation, cloud-enabled technologies.

Today, Gainwell offers one of the most comprehensive suites of scalable services and solutions on the market — all proven to deliver cost savings, better patient outcomes and an improved provider experience. Equally important to our expanding technologies and results: We bring ideas that bring policies to life.

Industry
IT & Software
Company Size
10,000+ employees
Headquarters
United States
Year Founded
Unknown
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