Senior Manager, Prior Authorizations (Pharmacist) - Missouri

Summary

As a Prior Authorization Operations Manager (Licensed Pharmacist) 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 by 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 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

What we're looking for

• 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 (including prior authorizations), medication pricing methodologies, NCPDP standards, electronic prior authorizations, financial management, and managed care statutes (retail experience does not count)
• 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 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

• This is a remote position within Missouri, with a preference for candidates located within 100 miles of Jefferson City, MO
• Ability to travel to Jefferson City, MO on a monthly basis is required
• Full-time, permanent, regular salaried (W-2) employee position

Applications will be accepted through May 28, 2026.