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

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

Senior Manager, Prior Authorizations – Pharmacist

Key skills