Medical Reviewer (Pharmacist) - Remote CA (West Sacramento, CA, US, 95605-1630)

It takes great medical minds to create powerful solutions that solve some of healthcare’s most complex 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 flexible hours. 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, continuous learning, and career development. Summary Gainwell Technologies is seeking a Medical Reviewer (Pharmacist) to provide pharmacy and clinical expertise supporting Medical Review Services for California healthcare programs. This role supports pharmacy review, claim adjudication, drug rebate activities, drug utilization review, Treatment Authorization Requests (TARs), and other Medical Review Services functions. Your role in our mission Perform pharmacy and medication-related clinical reviews. Support pharmacy claim review and adjudication activities. Provide clinical expertise for drug utilization review and drug-related authorization requests. Support drug rebate and pharmacy program activities as assigned. Review pharmacy documentation for compliance with applicable policies and coverage requirements. Provide technical expertise and assistance related to pharmacy review. Document findings and recommendations accurately and timely. Collaborate with physicians, n