Senior Manager, Prior Authorizations – Pharmacist
Location
Missouri
Posted
51 days ago
Salary
$122.2K - $174.6K / year
Seniority
Senior
Job Description
Senior Manager, Prior Authorizations – Pharmacist
Gainwell Technologies
• 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
Job 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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