Director of PBM Prior Authorization Operations
Apply for the Director of PBM Prior Authorization Operations role at Gainwell Technologies .
Summary
Lead innovative, high-performing pharmacy operations that improve access to care and drive measurable outcomes. As Director, you will oversee large‑scale teams responsible for clinical review, prior authorization, and utilization management programs that directly impact member and client experience. This position offers the opportunity to shape national pharmacy benefit operations and support Gainwell’s mission of delivering better health and human services outcomes.
Your Role in Our Mission
Lead a nationwide team of pharmacists, pharmacy technicians, and operations managers responsible for prior authorization and utilization management programs.
Oversee clinical review workflows, formulary and PDL adherence, and performance outcomes across PBM clients.
Serve as the strategic operations lead and clinical subject matter expert for all utilization management programs.
Partner with client leadership to ensure service excellence, compliance, and alignment with contractual obligations.
Implement data‑driven strategies to enhance efficiency, quality, and member outcomes across all pharmacy operations.
Forecast, budget, and manage staffing for a scalable, high‑volume team to meet seasonal and client demands.
What We’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 within a PBM or managed care setting.
Proven success managing large‑scale teams (100+ FTEs) and developing mid‑level and frontline leaders.
Demonstrated ability to improve key operational metrics such as turnaround time, accuracy, and customer satisfaction.
Strong understanding of Medicaid and PDL management processes and compliance standards.
Exceptional leadership, communication, and analytical skills with the ability to thrive in a fast‑paced environment.
What You Should Expect in This Role
Remote, full‑time position with national scope and cross‑functional collaboration.
Salary & Benefits
Pay range: $130,000.00 – $185,000.00 per year, base may vary by geography and experience.
All salaried, full‑time candidates are eligible for a generous, flexible vacation policy, a 401(k) employer match, comprehensive health benefits, and educational assistance.
Additional leadership and technical development academies to help build your skills and capabilities.
Seniority level: Director
Employment type: Contract
Job function: Management and Manufacturing – Industries: IT Services and IT Consulting
Gainwell Technologies is 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), age, sexual orientation, status as a protected veteran, status as an individual with a disability, or other applicable legally protected characteristics.
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