Prior Authorization Pharmacist – Oregon Medicaid

Gainwell Technologies

. Operate the Medicaid prescription drug program within state budget and legislative requirements .

Posted 10/14/2026full-timeRemote • Oregon • United StatesMid-LevelSenior💰 $90,900 - $129,900 per yearWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates expertise in clinical medication therapy evaluation and prior authorization processes, with strong communication skills for effective collaboration with healthcare providers and stakeholders. Proficient in utilizing relevant compendia and clinical trial data to support decision-making and quality improvement initiatives.

Highest-signal resume keywords

Clinical Medication Therapy EvaluationPrior Authorization ReviewManaged Care Pharmaceutical Service ExperienceHIPAA ComplianceMicrosoft Office Proficiency

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Clinical ReviewMedication Therapy EvaluationPrior Authorization RequestsUtilization ControlsData AnalysisQuality ImprovementPharmacy AuditsResearch SkillsImplementation SkillsConsultation Skills

Soft Skills

Communication SkillsTeam OrientationCollaboration SkillsOrganizational SkillsProblem Resolution Skills

Industry Keywords

Medicaid Prescription Drug ProgramPreferred Drug ListClinical GuidelinesPharmacy ProvidersDrug Rebate Program

About the role

Key responsibilities & impact

Operate the Medicaid prescription drug program within state budget and legislative requirements
Review prior authorization requests for alignment with Preferred Drug List criteria and clinical guidelines
Support peer-to-peer consultations with providers for timely authorization decisions
Conduct clinical evaluations of medication therapy using relevant compendia and clinical trial data
Contact prescribers for consultations and interventions regarding identified prescribing outliers
Review prior authorization data and identify intervention opportunities
Support written and verbal communications with members and physicians
Provide clinical input to call center agents handling provider and pharmacy calls
Contribute to continuous quality improvement and process enhancements
Collaborate with Medical Directors, Clinical Pharmacists, Clinical Specialty Pharmacists, product leaders, and pharmacy teams
Serve as a subject matter expert for pharmacy-related questions
Provide clinical input during weekly drug file updates and recommend utilization controls
Support Medicaid Drug Rebate Program operations
Assist the state with pharmacy audits using system claim details
Provide ongoing training to pharmacy providers
Produce annual reports and perform executive administrative duties for the state pharmacy program

Requirements

What you’ll need

Ability to communicate succinctly and accurately in both written and verbal English
Ability to perform clinical reviews using relevant compendia and clinical trial data
Managed care pharmaceutical service experience a plus
Strong research and implementation skills in practical settings
Analytical skills that translate into practical and pragmatic recommendations
Strong team orientation and respect for all members
Consultation and collaboration skills with internal and external stakeholders
Excellent organizational, written, and oral communication skills
Maintain confidentiality and comply with HIPAA
Highly skilled with Microsoft Office products and able to quickly learn proprietary systems
Proficient with work organization and problem resolution skills
Pharmacist expertise and clinical medication therapy evaluation knowledge
Experience reviewing prior authorization requests using Preferred Drug List criteria

Benefits

Comp & perks

Flexible hours
Work-life balance
Continuous learning and career development
Flexible vacation policy
401(k) employer match
Comprehensive health benefits
Educational assistance
Leadership and technical development academies