Job Description

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

Join Gainwell as a Certified Pharmacy Technician (CPhT) and support Rhode Island Medicaid and other state pharmacy programs through pharmacy claims, prior authorization, provider support, eligibility, formulary, and program operations. In this fully remote role, you will work closely with state agency personnel, providers, pharmacies, and internal teams to research and resolve pharmacy-related issues and support accurate program administration. This opportunity is ideal for an experienced Certified Pharmacy Technician with managed care, PBM, health plan, or pharmacy-benefit experience who is comfortable serving as a pharmacy program resource.

Your role in our mission

• Maintain day-to-day relationships with state agency personnel while supporting eligibility updates, reporting, formulary activities, and prior authorization support.
• Support state agency pharmacy programs, policies, processes, and reporting requirements, including POS and HCPCS adjudication related to medication prior authorizations.
• Review, research, and process pharmacy prior authorization requests in accordance with established criteria, policies, regulatory requirements, FDA guidance, and service-level expectations.
• Research and resolve program, member, provider, and pharmacy inquiries, including provider enrollment questions involving limited distribution drugs, while documenting activity accurately.
• Partner with internal departments on pharmacy initiatives, provide pharmacy program subject-matter expertise, and help identify opportunities to improve quality and operational performance.

What we're looking for

• Active Certified Pharmacy Technician credential (PTCB/CPhT, ExCPT, or equivalent) required .
• Two or more years of relevant pharmacy technician experience, preferably within managed care, health insurance, PBM, pharmacy benefits, Medicaid, or a related healthcare environment.
• Experience with pharmacy prior authorizations, prescription claims, medication terminology, and member, provider, or pharmacy support.
• Experience with POS claims, HCPCS, provider enrollment, formularies, eligibility, or related pharmacy program operations is highly desirable.
• Strong communication, research, problem-solving, computer, and organizational skills with the ability to navigate multiple systems in a fast-paced remote environment.

What you should expect in this role

• Full-time, non-exempt, 100% remote/work-from-home position for candidates residing within the United States .
• Monday through Friday schedule, 8:00 a.m.–5:00 p.m. Eastern Time .
• Frequent interaction with state agency personnel, members, providers, pharmacies, pharmacy technicians, leadership, and internal stakeholders.
• Reliable high-speed internet and a professional, distraction-free home workspace are required.
• Access to Gainwell’s competitive benefits package for eligible employees including medical, dental, vision, and 401(k) options in accordance with applicable eligibility guidelines.  

#LI-REMOTE

#LI-JT1

The pay range for this position is $39,000 – $52,000 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’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 , 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’ll be joining a company where collaboration, innovation, and inclusion fuel our growth. Learn more about Gainwell at our and visit our 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 “wages” and “wage rates” to include “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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