Senior Manager, Prior Authorizations – Pharmacist
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Job Description
Prior Authorization Operations Manager at Gainwell leading a team managing pharmacy prior authorizations. Collaborating across departments to improve health outcomes for clients and members.
Responsibilities:
- Oversight of prior authorization, pharmacist appeals, and peer-to-peer DLP creation, modification, training, and implementation
- Collaboration with internal leaders/teams including, but not limited to: Claims, Grievance and Appeals, Clinical, Quality Assurance, Network, and Training
- Evaluate drug and drug class reviews following evidence-based research and processes widely accepted by the medical community
- Maintain up-to-date knowledge of medications, drugs, and prescribing practices; advise Gainwell leaders based on your knowledge and expertise
- Help write consultation and intervention scripts to support continuous improvement and quality improvement processes
- Assist Gainwell clinical leadership in reviewing clinical criteria and Preferred Drug List (PDL) recommendations used to make coverage and PDL placement decisions
Requirements:
- 5 or more years of experience leading a team of pharmacists managing prior authorizations
- Must hold an active pharmacist license in the state of Missouri
- Prior management experience (non-retail) is required
- Experience with pharmacy claims, clinical operations, medication pricing methodologies, NCPDP standards, electronic prior authorizations, financial management, and managed care statutes
- Knowledge of current research and best practices related to specialty medications
- Analytical and research expertise to conduct drug class and clinical reviews involving prescribing behavior
- 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
Benefits:
- Comprehensive health benefits
- 401(k) employer match
- Flexible vacation policy
- Educational assistance
- Leadership and technical development academies
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