Senior Manager, Prior Authorizations – Pharmacist

Gainwell Technologies

. Oversight of prior authorization, pharmacist appeals, and peer-to-peer DLP creation, modification, training, and implementation .

Posted 4/9/2026full-timeRemote • Montana • 🇺🇸 United StatesSenior💰 $122,200 - $174,600 per yearWebsite

About the role

Key responsibilities & impact

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

What you’ll need

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

Comp & perks

Comprehensive health benefits
401(k) employer match
Flexible vacation policy
Educational assistance
Leadership and technical development academies

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills & Tools

prior authorizationpharmacy claimsclinical operationsmedication pricing methodologiesNCPDP standardselectronic prior authorizationsfinancial managementmanaged care statutesdrug class reviewsclinical reviews

Soft Skills

leadershipcollaborationanalytical skillsresearch expertisewritten communicationoral communicationclinical communicationdelegationteamworkcontinuous improvement

Certifications

active pharmacist license