Qureos Mentor

Gainwell Technologies

<div>
 It takes great medical minds to create powerful solutions that solve some of healthcare&rsquo;s most complex challenges. Join us and put your expertise to work in ways you never imagined possible. We know you&rsquo;ve honed your career in a fast-moving medical environment. While Gainwell operates with a sense of urgency, you&rsquo;ll have the opportunity to work more flexible hours. And working at Gainwell carries its rewards. You&rsquo;ll have an incredible opportunity to grow your career in a company that values work-life balance, continuous learning, and career development.
 
 
 
 Summary
 
 
 
 We are seeking a talented individual for the Nurse Reviewer, Associate position. In this role, you will perform clinical reviews to determine whether medical record documentation supports the need for a service, based on clinical criteria, coverage policies, and utilization and practice guidelines as defined by the review methodologies specific to the contract. This involves accessing proprietary systems to audit medical records, accurately documenting findings, and providing policy and regulatory support for determinations.
 
 
 
 Essential Job Functions
 
 
 
 <ul>
 <li>
 Review and interpret medical records, comparing them against criteria to determine the appropriateness and reasonableness of care. Apply critical thinking and decision-making skills to assess whether the documentation supports the need for the service while maintaining production goals and quality standards.
 </li>
 <li>
 Document decisions and rationale to justify review findings or no findings.
 </li>
 <li>
 Determine approvals or initiate referrals to the physician consultant, processing their decisions while ensuring denials are explained in sufficient detail and completed within contractual deadlines.
 </li>
 <li>
 Perform prior authorization, precertification, and retrospective reviews, and prepare decision letters as needed in support of the utilization review contract.
 </li>
 <li>
 Maintain current knowledge of clinical criteria guidelines and complete required CEUs to maintain RN licensure.
 </li>
 <li>
 Attend training and scheduled meetings to enhance skills and working knowledge of clinical policies, procedures, rules, and regulations.
 </li>
 <li>
 Actively cross-train to perform reviews of multiple claim types, providing a flexible workforce to meet client needs.
 
 
 </li>
 </ul>
 
 What We're Looking For
 
 
 
 <ul>
 <li>
 Active, unrestricted RN licensure from the United States and in your state of primary residence; an active compact multistate RN license as defined by the Nurse Licensure Compact (NLC) is also required.
 </li>
 <li>
 3+ years of clinical experience in an inpatient hospital setting.
 </li>
 <li>
 1+ years of experience in utilization review or claims auditing.
 </li>
 <li>
 Experience using Milliman or InterQual criteria is preferred.
 </li>
 <li>
 Demonstrated proficiency in computer skills, including Microsoft Windows, Outlook, Excel, Word, PowerPoint, internet browsers, and typing.
 
 
 </li>
 </ul>
 
 What You Should Expect In This Role
 
 
 
 <ul>
 <li>
 Home-based position; you must have a work location within the continental U.S.
 </li>
 <li>
 Must provide a high-speed internet connection and a work environment free from distractions.
 </li>
 <li>
 Full-time schedule during normal business hours is required, as the role involves frequent interactions with the team and other departments.
 </li>
 <li>
 May be required to work extended hours for special business needs.
 </li>
 <li>
 May be required to travel up to 10% of the time based on business needs.
 
 
 </li>
 </ul>
 This position is for pipeline purposes, and we welcome applications on an ongoing basis.
 
 
 The pay range for this position is $70,000.00 - $80,000.00 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&rsquo;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&rsquo;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 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. Gainwell Technologies defines &ldquo;wages&rdquo; and &ldquo;wage rates&rdquo; to include &ldquo;all forms of pay, including, but not limited to, salary, overtime pay, bonuses, stock, stock options, profit sharing and bonus plans, life insurance, vacation and holiday pay, cleaning or gasoline allowances, hotel accommodations, reimbursement for travel expenses, and benefits.
 
</div>

Nurse Reviewer Associate- Remote

<div>
 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&rsquo;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
 
 Call Center Representative - Remote US
 
 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 &mdash; a community&rsquo;s most vulnerable. Connect your passion with purpose, teaming with people who thrive on finding innovative solutions to some of healthcare&rsquo;s biggest challenges. Here are the details on this position.
 
 
 
 Your role in our mission
 
 
 
 This is an important position in Gainwell&rsquo;s commitment to helping clients deliver better health and human services outcomes.
 
 
 <ul>
 <li>
 Provide knowledgeable responses to basic client questions; elevate more complex cases to appropriate staff as needed
 </li>
 <li>
 Put your skills to work to solve client problems, update account history and follow up with clients to confirm their inquiry or request is resolved
 </li>
 <li>
 Adhere to the client&rsquo;s SLAs and consistently meet production targets
 </li>
 <li>
 Collaborate with team members, management and clients to resolve client inquiries; cross-train new resources in customer service processes
 </li>
 <li>
 Process client inquiries more efficiently and effectively by reviewing and recommending changes to procedures and workflow
 
 
 </li>
 </ul>
 
 What We're Looking For
 
 
 
 <ul>
 <li>
 2 or more years of customer service experience in any industry
 </li>
 <li>
 Knowledge of basic help desk software, computer software and Microsoft Office applications
 </li>
 <li>
 Strong problem-solving skills to bring inquiries to effective resolution
 </li>
 <li>
 Strong customer service skills with an emphasis on written and oral communication to respond to inquiries professionally
 </li>
 <li>
 Ability to understand your role on a team and identify the correct stakeholders to consult to resolve client inquiries
 
 
 </li>
 </ul>
 
 What You Should Expect In This Role
 
 
 
 <ul>
 <li>
 This is a remote position in the USA.
 </li>
 <li>
 Specific shift assignments will fall within this time range based on business needs.
 </li>
 <li>
 Requires ability to communicate clearly via phone and computer; manual dexterity for office equipment use.
 </li>
 <li>
 As part of the screening process, qualified applicants will complete a short JobTwine video interview.
 </li>
 <li>
 Harver Assessment Requirement: As part of our interview process, all candidates must complete the Harver Assessment. This assessment helps us evaluate key competencies relevant to the role, including communication skills, multitasking abilities, and problem-solving capabilities.
 </li>
 <li>
 Video cameras must be used during all interviews, as well as during the initial week of orientation. To work effectively as a teleworker or hybrid positions with Gainwell, employees must have a broadband internet connection with a minimum speed of 24 Mbps download and 8 Mbps upload. Higher speeds are recommended for optimal performance.
 </li>
 <li>
 To test your internet speed, go to Google and search for &ldquo;Internet Speed Test.&rdquo;
 
 
 </li>
 </ul>
 
 This posting is intended for pipelining. We will accept applications on an ongoing basis.
 
 
 
 The pay range for this position is $29,100 - 41,600 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&rsquo;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&rsquo;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 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. Gainwell Technologies defines &ldquo;wages&rdquo; and &ldquo;wage rates&rdquo; to include &ldquo;all forms of pay, including, but not limited to, salary, overtime pay, bonuses, stock, stock options, profit sharing and bonus plans, life insurance, vacation and holiday pay, cleaning or gasoline allowances, hotel accommodations, reimbursement for travel expenses, and benefits.
 
 
 
</div>

Call Center Representative - Remote US

<div>
 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&rsquo;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
 
 
 
 We are seeking a dynamic and results-driven Healthcare Contact Center Manager to oversee daily operations and play a critical role in implementing new systems, tools, and customer service initiatives. This is an ideal opportunity for a proven leader with experience in contact center management and a strong track record of driving successful implementations&mdash;from technology rollouts to new site launches and process redesigns.
 
 
 
 Your role in our mission
 
 
 
 <ul>
 <li>
 Lead and optimize day-to-day operations across multiple customer support channels (phone, email, chat, web messaging).
 </li>
 <li>
 Monitor key performance metrics such as AHT, FCR, and SLAs to drive continuous improvement.
 </li>
 <li>
 Partner with Workforce Management to build effective staffing strategies.
 </li>
 <li>
 Coach, mentor, and develop team leads to ensure peak performance and engagement.
 </li>
 <li>
 Lead or support key implementations&mdash;including new CRM systems, IVR, WFM tools, and service delivery models&mdash;working cross-functionally with IT, HR, Product, and Marketing.
 </li>
 <li>
 Manage implementation timelines, risk assessments, training plans, and post-launch reviews.
 </li>
 <li>
 Identify and mitigate the operational impacts of change initiatives.
 </li>
 <li>
 Provide strategic recommendations to leadership by leveraging data-driven insights and contact center best practices.
 
 
 </li>
 </ul>
 
 What We're Looking For
 
 
 
 <ul>
 <li>
 Five (5) or more years of leadership experience in a healthcare (Medicaid/Medicare) contact center environment required.
 </li>
 <li>
 Two (2) or more years of experience leading or supporting large-scale implementations (e.g., systems, site launches, or process changes) required.
 </li>
 <li>
 Strong understanding of contact center technologies such as CRM platforms, telephony systems, WFM, and QA tools required.
 
 
 </li>
 </ul>
 
 What You Should Expect In This Role
 
 
 
 <ul>
 <li>
 On-site role in Gainwell&rsquo;s DC Office with no remote opportunities.
 </li>
 <li>
 This is a full-time permanent regular salaried (W-2) employee position.
 </li>
 <li>
 Health (medical, dental, vision) benefits start on day 1 of employment.
 </li>
 <li>
 Company match 401K and other benefits available within months of starting.
 </li>
 <li>
 New employees are eligible to take advantage of flexible vacation policy after ninety (90) calendar days of employment. Any exception requires manager approval prior to employee's Gainwell start date.
 </li>
 <li>
 Company provided computer for work use.
 </li>
 <li>
 Video cameras must be used during all interviews, as well as during the initial week of orientation if hired.
 
 
 </li>
 </ul>
 The deadline to submit applications for this posting is April 20, 2026.
 
 
 The pay range for this position is $81,000.00 - $115,700.00 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&rsquo;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&rsquo;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 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. Gainwell Technologies defines &ldquo;wages&rdquo; and &ldquo;wage rates&rdquo; to include &ldquo;all forms of pay, including, but not limited to, salary, overtime pay, bonuses, stock, stock options, profit sharing and bonus plans, life insurance, vacation and holiday pay, cleaning or gasoline allowances, hotel accommodations, reimbursement for travel expenses, and benefits.
 
</div>

Contact Center Manager

<div>
 It takes great medical minds to create powerful solutions that solve some of healthcare&rsquo;s most complex challenges. Join us and put your expertise to work in ways you never imagined possible. We know you&rsquo;ve honed your career in a fast-moving medical environment. While Gainwell operates with a sense of urgency, you&rsquo;ll have the opportunity to work more flexible hours. And working at Gainwell carries its rewards. You&rsquo;ll have an incredible opportunity to grow your career in a company that values work-life balance, continuous learning, and career development.
 
 
 
 Summary
 
 
 
 The Prior Authorization (PA) Pharmacist is responsible for reviewing prior authorization requests from providers to ensure safe and effective medication utilization. The PA pharmacist will work with internal and external stakeholders in evaluating and continually developing a strategy for Utilization Management.
 
 
 
 Your role in our mission
 
 
 
 <ul>
 <li>
 Review Prior Authorization requests from medical professionals to ensure alignment with Preferred Drug List (PDL) criteria and current clinical guidelines
 </li>
 <li>
 Support peer-to-peer discussions with medical providers regarding Prior Authorization reviews
 </li>
 <li>
 Collaborate on the refinement of consultation scripting; solicit and utilize input from those contacted to improve scripting
 </li>
 <li>
 Contribute to the success of the Clinical Call Centers and Prior Authorization department by assisting with the implementation and management of both written and verbal communications to members and physicians; available for consultation on pharmacy-related questions and issues within the organization
 </li>
 <li>
 Contribute to program improvements by using continuous quality improvement processes, proactively identifying opportunities, and providing ongoing consultation and collaboration with product leaders
 </li>
 <li>
 Uphold the clinical integrity of pharmaceutical solutions by staying up to date on medication information and clinical guidelines, contributing to the identification of pharmacy program best practices, and collaborating with Medical Directors and Clinical Pharmacists to provide pharmacy expertise
 </li>
 <li>
 Collaborate internally with the pharmacy team (Pharmacy Manager, PDL Coordinator, Clinical Pharmacists) to identify trends or areas to explore, with the intent of identifying new drugs and therapeutic classes requiring utilization management
 </li>
 <li>
 Other duties as assigned
 </li>
 <li>
 Contribute creative solutions to improve the operational efficiency and effectiveness of the pharmacy team
 
 
 </li>
 </ul>
 
 Requirements
 
 
 
 <ul>
 <li>
 PharmD or B.S. in Pharmacy with relevant specialty background
 </li>
 <li>
 Registered Pharmacist with an unrestricted state license (Texas Pharmacist License preferred but not required)
 </li>
 <li>
 4 years of experience in clinical pharmacy
 </li>
 <li>
 Strong verbal and written communication skills
 </li>
 <li>
 Highly skilled in Microsoft Office products and able to quickly learn proprietary systems
 </li>
 <li>
 Expected working hours: 10:00 am to 7:00 om CST, including select holidays and occasional weekend on-call coverage
 
 
 </li>
 </ul>
 
 Basic Qualifications
 
 
 
 <ul>
 <li>
 Experience in coordinating and collaborating with work teams preferred
 </li>
 <li>
 Ability to perform clinical reviews using relevant compendia and clinical trial data
 </li>
 <li>
 Managed care and/or prior authorization experience is a plus
 </li>
 <li>
 Strong research and implementation skills in practical settings
 </li>
 <li>
 Analytical skills that translate into practical and pragmatic recommendations
 </li>
 <li>
 Strong team orientation with respect for all members
 </li>
 <li>
 Strong interpersonal skills that support effective consultation and collaboration with internal and external stakeholders who do not directly report to this role
 </li>
 <li>
 Prior call center experience preferred
 
 
 </li>
 </ul>
 
 Work Environment
 
 
 
 <ul>
 <li>
 Work from home
 </li>
 <li>
 Reliable high-speed internet connectivity required
 </li>
 <li>
 A dedicated, private (HIPAA-compliant) workspace without distractions
 
 
 </li>
 </ul>
 Applications will be accepted through April 28, 2026.
 
 
 The pay range for this position is $90,000.00 - $129,900.00 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&rsquo;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&rsquo;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 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. Gainwell Technologies defines &ldquo;wages&rdquo; and &ldquo;wage rates&rdquo; to include &ldquo;all forms of pay, including, but not limited to, salary, overtime pay, bonuses, stock, stock options, profit sharing and bonus plans, life insurance, vacation and holiday pay, cleaning or gasoline allowances, hotel accommodations, reimbursement for travel expenses, and benefits.
 
</div>

Prior Authorization Pharmacist - Texas Medicaid (Remote)

<div>
 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&rsquo;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
 
 
 
 We&rsquo;re seeking a motivated and energetic individual to join our team in Baton Rouge, LA as a Provider Services Call Center Agent. In this role, you will assist healthcare professionals with billing requirements, policy questions, and other Medicaid-related inquiries. You'll be expected to research complex issues, maintain up-to-date knowledge of policies, and log all interactions accurately.
 
 
 This position requires excellent oral and written communication skills, strong customer service abilities, professional telephone etiquette, and a positive, patient attitude. Candidates should be self-starters who can multitask and solve problems effectively in a fast-paced environment. Proficiency in Microsoft Office and the ability to navigate multiple computer systems is essential.
 
 
 
 Your role in our mission
 
 
 
 <ul>
 <li>
 Handle a high volume of inbound calls and provide accurate assistance to healthcare providers.
 </li>
 <li>
 Meet and maintain performance standards, including resolving 92% of provider calls within 3&ndash;5 minutes, as required by contract.
 </li>
 <li>
 Communicate professionally and efficiently with providers to resolve issues.
 </li>
 <li>
 Accurately log and track all call interactions in the designated call tracking system.
 </li>
 <li>
 Support team objectives and collaborate with coworkers to meet departmental goals.
 </li>
 <li>
 Demonstrate strong multitasking and information retention abilities in a high-paced environment.
 </li>
 <li>
 Maintain effective and professional relationships with clients, coworkers, providers, and members.
 </li>
 <li>
 Adhere to scheduled work hours and maintain consistent attendance.
 </li>
 <li>
 Uphold HIPAA compliance and ensure confidentiality of sensitive information.
 
 
 </li>
 </ul>
 
 What We're Looking For
 
 
 
 <ul>
 <li>
 High School Diploma or equivalent (GED)
 </li>
 <li>
 1&ndash;2 years of experience in customer service or a call center environment; healthcare experience preferred
 </li>
 <li>
 Basic proficiency with Microsoft Office applications (Outlook, Word, Excel)
 </li>
 <li>
 Experience working with Medicaid programs preferred
 </li>
 <li>
 Familiarity with medical claims processing or review preferred
 
 
 </li>
 </ul>
 
 What You Should Expect In This Role
 
 
 
 <ul>
 <li>
 Schedule: This is primarily a remote position; however, candidates must reside within driving distance of our Baton Rouge office (8591 United Plaza Blvd, Suite 270, Baton Rouge, LA 70809). . The standard work hours are Monday through Friday, 8:00 AM to 5:00 PM CST.
 </li>
 <li>
 Training: A comprehensive training program will be provided prior to onboarding. Training typically lasts 6 to 8 weeks.
 </li>
 <li>
 Assessment Requirement: All candidates are required to complete a Harver Assessment as part of the application process. This assessment evaluates key competencies such as communication, multitasking, and problem-solving.
 </li>
 <li>
 Video Interview Requirement: Candidates must use a webcam for all interviews and during the first week of orientation.
 </li>
 <li>
 Internet Requirements (for remote work):
 </li>
 <ul>
 <li>
 A broadband internet connection with a minimum speed of 24 Mbps download and 8 Mbps upload is required.
 </li>
 <li>
 Higher speeds are recommended to ensure optimal performance.
 </li>
 <li>
 To test your internet speed, go to Google and search: &ldquo;Internet Speed Test.&rdquo;
 
 </li>
 </ul>
 </ul>
 &ldquo;This posting is intended for pipelining. We will accept applications on an ongoing basis.&rdquo;
 
 
 The pay range for this position is $29,100.00 - $41,600.00 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&rsquo;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&rsquo;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 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.
 
</div>

Call Center Representative - Baton Rouge, LA - Remote

<div>
 It takes great medical minds to create powerful solutions that solve some of healthcare&rsquo;s most complex challenges. Join us and put your expertise to work in ways you never imagined possible. We know you&rsquo;ve honed your career in a fast-moving medical environment. While Gainwell operates with a sense of urgency, you&rsquo;ll have the opportunity to work more flexible hours. And working at Gainwell carries its rewards. You&rsquo;ll have an incredible opportunity to grow your career in a company that values work-life balance, continuous learning, and career development.
 
 
 
 Summary
 
 
 
 Gainwell Technologies is seeking a Certified Pharmacy Technician - Remote US to support a high-volume PBM clinical and technical call center environment. In this fully remote role, you will assist with provider inquiries, process prior authorizations, and help ensure timely, accurate resolution of pharmacy-related requests while maintaining compliance with HIPAA, state regulations, and internal quality standards.
 
 
 
 Your role in our mission
 
 
 
 <ul>
 <li>
 Process prior authorization requests within required turnaround times and complete approvals when pharmacist review is not needed.
 </li>
 <li>
 Handle provider inquiries efficiently across phone, email, fax, and web-based channels, aiming for first-contact resolution whenever possible.
 </li>
 <li>
 Conduct outbound communication to providers to obtain missing information and support closure of pending prior authorization cases.
 </li>
 <li>
 Accurately document all interactions, decisions, and follow-up actions in the appropriate systems.
 </li>
 <li>
 Follow established workflows, productivity expectations, and quality standards while identifying opportunities for process improvement.
 
 
 </li>
 </ul>
 
 What We're Looking For
 
 
 
 <ul>
 <li>
 Active Certified Pharmacy Technician (CPhT) certification and/or active Pharmacy Technician registration as required by applicable Board of Pharmacy regulations.
 </li>
 <li>
 At least 2 years of pharmacy technician experience, preferably in retail, hospital, managed care, PBM, insurance, or prior authorization support.
 </li>
 <li>
 Strong knowledge of drug terminology, pharmacy operations, and pharmacy benefit or claims-related processes.
 </li>
 <li>
 Experience working in a fast-paced, metrics-driven environment with strong attention to detail and accuracy.
 </li>
 <li>
 Proficiency in Microsoft Office applications and the ability to quickly learn internal systems and workflows.
 
 
 </li>
 </ul>
 
 What You Should Expect In This Role
 
 
 
 <ul>
 <li>
 Fully remote position supporting a high-volume call center operation.
 </li>
 <li>
 Frequent interaction with providers through phone, email, fax, and web portals.
 </li>
 <li>
 Strict adherence to HIPAA, PHI, regulatory, and turnaround-time requirements.
 </li>
 <li>
 Performance expectations tied to productivity, quality, and service metrics.
 </li>
 <li>
 Comprehensive benefits package including medical, dental, vision, 401(k) with company match, paid time off, floating holidays, and wellness programs.
 
 
 </li>
 </ul>
 The pay range for this position is $33,500.00 - $47,900.00 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&rsquo;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&rsquo;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 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. Gainwell Technologies defines &ldquo;wages&rdquo; and &ldquo;wage rates&rdquo; to include &ldquo;all forms of pay, including, but not limited to, salary, overtime pay, bonuses, stock, stock options, profit sharing and bonus plans, life insurance, vacation and holiday pay, cleaning or gasoline allowances, hotel accommodations, reimbursement for travel expenses, and benefits.
 
 
 
</div>

Certified Pharmacy Technician - Remote US

<div>
 It takes great medical minds to create powerful solutions that solve some of healthcare&rsquo;s most complex challenges. Join us and put your expertise to work in ways you never imagined possible. We know you&rsquo;ve honed your career in a fast-moving medical environment. While Gainwell operates with a sense of urgency, you&rsquo;ll have the opportunity to work more flexible hours. And working at Gainwell carries its rewards. You&rsquo;ll have an incredible opportunity to grow your career in a company that values work-life balance, continuous learning, and career development.
 
 
 
 Summary
 
 
 
 The Prior Authorization (PA) Pharmacist is responsible for reviewing prior authorization requests from providers to ensure safe and effective medication utilization. The PA Pharmacist will work with internal and external stakeholders to evaluate and continually develop strategies for Utilization Management.
 
 
 
 Essential Job Functions
 
 
 
 <ul>
 <li>
 Review prior authorization requests from medical professionals to ensure alignment with Preferred Drug List (PDL) criteria and current clinical guidelines.
 </li>
 <li>
 Support peer-to-peer discussions with medical providers regarding prior authorization reviews.
 </li>
 <li>
 Collaborate on the refinement of consultation scripting; solicit and utilize input from those contacted to improve scripting.
 </li>
 <li>
 Contribute to the success of the Clinical Call Centers and Prior Authorization department by assisting with the implementation and management of both written and verbal communications to members and physicians. Serve as a resource for pharmacy-related questions and issues across the organization.
 </li>
 <li>
 Contribute to program improvements by using continuous quality improvement processes, proactively identifying opportunities, and providing ongoing consultation and collaboration with product leaders.
 </li>
 <li>
 Uphold the clinical integrity of pharmaceutical solutions by staying up to date on medication information and clinical guidelines, contributing to the identification of pharmacy program best practices, and collaborating with Medical Directors and Clinical Pharmacists to provide pharmacy expertise.
 </li>
 <li>
 Collaborate internally with the pharmacy team (Pharmacy Manager, PDL Coordinator, Clinical Pharmacists) to identify trends or areas of opportunity, with the intent of identifying new drugs and therapeutic classes requiring utilization management.
 </li>
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 Perform other duties as assigned.
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 <li>
 Contribute creative solutions to improve the operational efficiency and effectiveness of the pharmacy team.
 
 
 </li>
 </ul>
 
 Requirements
 
 
 
 <ul>
 <li>
 PharmD or B.S. in Pharmacy with relevant specialty background.
 </li>
 <li>
 Registered Pharmacist with an unrestricted state license (Connecticut Pharmacist License preferred but not required).
 </li>
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 Minimum of four (4) years of experience in clinical pharmacy.
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 <li>
 Strong verbal and written communication skills.
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 <li>
 Highly proficient in Microsoft Office products and ability to quickly learn proprietary systems.
 
 
 </li>
 </ul>
 
 Basic Qualifications
 
 
 
 <ul>
 <li>
 Experience coordinating and collaborating with work teams preferred.
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 <li>
 Ability to perform clinical reviews using relevant compendia and clinical trial data.
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 <li>
 Managed care and/or prior authorization experience is a plus.
 </li>
 <li>
 Strong research and implementation skills in practical settings.
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 <li>
 Analytical skills that translate into practical and pragmatic recommendations.
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 <li>
 Strong team orientation with respect for all members.
 </li>
 <li>
 Strong interpersonal skills to support effective consultation and collaboration with internal and external stakeholders who do not directly report to this role.
 </li>
 <li>
 Prior call center experience preferred.
 
 
 </li>
 </ul>
 
 Work Environment
 
 
 
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 <li>
 Work from home; reliable high-speed internet connectivity is required.
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 Expected working hours: 9:00 AM to 5:00 PM Eastern Time, including select holidays and occasional weekend on-call coverage.
 </li>
 <li>
 A dedicated, private workspace (HIPAA-compliant) with high-speed internet access is required.
 
 
 </li>
 </ul>
 Applications for this posting will be accepted until April 24, 2026.
 
 
 The pay range for this position is $90,900.00 - $129,900.00 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&rsquo;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&rsquo;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 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. Gainwell Technologies defines &ldquo;wages&rdquo; and &ldquo;wage rates&rdquo; to include &ldquo;all forms of pay, including, but not limited to, salary, overtime pay, bonuses, stock, stock options, profit sharing and bonus plans, life insurance, vacation and holiday pay, cleaning or gasoline allowances, hotel accommodations, reimbursement for travel expenses, and benefits.
 
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Prior Authorization Pharmacist - Connecticut Medicaid (Remote)

Join Gainwell Technologies and explore 7   exciting career opportunities. They're hiring for various roles with options for remote or on-site work. Apply today and become part of their innovative team.