Prior Authorization Operations Manager

Great companies need great teams to propel their operations. Join the group that solves business challenges and enhances the way we work and grow. Working at Gainwell carries its rewards. You’ll have an incredible opportunity to grow your career in a company that values your contributions and puts a premium on work flexibility, learning, and career development. 

Summary

As a Prior Authorization Operations Manager 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.
• Oversight of prior authorization, pharmacist appeal 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

What we're looking for

• 5 or more years of experience in a clinical pharmacy setting, with managed care pharmaceutical service experience a plus 
• Prior management experience required
• Experience with pharmacy claims, clinical operations (including prior authorizations) medication pricing methodologies, NCPDP standards, electronic prior authorizations, financial management and managed care statute.
• 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

• Remote
• Travel up to 25% to Dublin, OH

The deadline to submit applications for this posting is 12/6/2024.

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The pay range for this position is $113,900.00 - $162,700.00 per year, however, the base pay offered may vary depending on geographic region, internal equity, job-related knowledge, skills, and experience among other factors. Put your passion to work at Gainwell. You’ll have the opportunity to grow your career in a company that values work flexibility, learning, and career development. All salaried, full-time candidates are eligible for our generous, flexible vacation policy, a 401(k) employer match, comprehensive health benefits, and educational assistance. We also have a variety of leadership and technical development academies to help build your skills and capabilities.

We believe nothing is impossible when you bring together people who care deeply about making healthcare work better for everyone. Build your career with Gainwell, an industry leader. You’ll be joining a company where collaboration, innovation, and inclusion fuel our growth. Learn more about Gainwell at our company website and visit our Careers site for all available job role openings.

Gainwell Technologies is committed to a diverse, equitable, and inclusive workplace. We are proud to be an Equal Opportunity Employer, where all qualified applicants will receive consideration for employment without regard to race, religion, color, national origin, gender (including pregnancy, childbirth, or related medical condition), sexual orientation, gender identity, gender expression, age, status as a protected veteran, status as an individual with a disability, or other applicable legally protected characteristics. We celebrate diversity and are dedicated to creating an inclusive environment for all employees.