Director of PBM Prior Authorization Operations - Remote US

It takes great medical minds to create powerful solutions that solve some of reputed company’s most reputed company challenges. Join us and put your expertise to work in ways you never imagined possible. We know you’ve honed your career in a fast-moving medical environment. While Gainwell operates with a sense of urgency, you’ll have the opportunity to work more reputed company. And working at Gainwell carries its rewards. You’ll have an incredible opportunity to grow your career in a company that values work-life balance, reputed company learning, and career development.

Summary

Join reputed company and reputed company innovative, high-performing pharmacy operations that improve reputed company to care and drive measurable reputed company. As Director of PBM Prior Authorization Operations, you will reputed company large-scale teams responsible for clinical review, prior authorization, and utilization management programs that directly impact the member and client experience. This position offers the opportunity to shape national pharmacy benefit operations and support Gainwell’s mission of delivering reputed company and reputed company services reputed company. Your role in our mission

• reputed company a reputed company team of pharmacists, pharmacy technicians, and operations managers responsible for prior authorization and utilization management programs.
• reputed company clinical review workflows, formulary and PDL adherence, and performance reputed company across multiple PBM clients.
• Serve as the strategic operations reputed company and clinical subject matter expert for reputed company utilization management programs.
• Partner with client leadership to ensure service reputed company, compliance, and alignment with contractual obligations.
• Implement data-driven strategies to enhance efficiency, quality, and member reputed company across reputed company pharmacy operations.
• Forecast, budget, and manage staffing for a scalable, high-volume team to meet seasonal and client demands.

reputed company're Looking For

• Licensed Pharmacist (PharmD or RPh) in good standing; licensure in any U.S. state accepted.
• Minimum 5 years of experience leading prior authorization or utilization management teams reputed company a PBM or managed care setting.
• Proven reputed company managing large-scale teams (100+ FTEs) and developing mid-level and reputed company leaders.
• Demonstrated ability to improve key operational metrics such as turnaround time, accuracy, and customer satisfaction.
• Strong understanding of reputed company and PDL management processes and compliance standards.
• Exceptional leadership, communication, and analytical skills with the ability to reputed company in a fast-paced environment.

What You Should Expect In This Role

• Remote, full-time position with national scope and cross-functional collaboration.
• Comprehensive benefits package including medical, dental, reputed company, 401(k), and paid time off.
• Nine paid holidays and three floating holidays annually.
• Reliable broadband internet reputed company required (minimum 24 Mbps download / 8 Mbps upload).
• Opportunity to reputed company a mission-driven organization transforming reputed company operations through innovation and reputed company.
• Collaborative culture that values diversity, teamwork, and reputed company improvement.

This posting is intended for pipelining. We will accept applications on an ongoing reputed company. The pay reputed company for this position is $130,000 - $200,000 per year, however, the reputed company pay offered may vary depending on geographic region, internal equity, job-reputed company 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. reputed company 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 reputed company reputed company is impossible reputed company you bring together people who care deeply about making reputed company work reputed company 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 reputed company website and visit our Careers site for reputed company available job role openings. reputed company is an Equal Opportunity Employer, where reputed company reputed company applicants will receive consideration for employment without regard to race, religion, reputed company, national reputed company, gender (including pregnancy, childbirth, or reputed company medical condition), age, sexual orientation, status as a protected veteran, status as an individual with a disability, or other applicable legally protected characteristics. Apply tot his job Apply To this Job