Summary As a  Pharmacy Business Analyst - Conversion & Prior Auth SME 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 — a community’s most vulnerable. Connect your passion with purpose, teaming with people who thrive on finding innovative solutions to some of healthcare’s biggest challenges. Here are the details on this position. Your role in our mission

Play a critical part in ensuring Gainwell is meeting our clients’ objectives in pharmacy benefit management (PBM) services. Support PBM or Drug rebate implementations and configurations

Support PBM operations and maintenance on established accounts

Work with a team of pharmacy clinicians and subject matter experts to configure the pharmacy systems to deliver services to our state clients.

Assist in implementation of a pharmacy payer system.

Perform Pharmacy updates including benefit plan design, edit/audit set up, utilization controls, PDL, configuration updates, and auto prior authorization parameters

Be a knowledgeable bridge between operations staff, clients, project managers and technical staff to define, document and share pharmacy business requirements and expected impact

Work with the client to develop business rules and configuration requirements

Analyze, plan, design, document or make recommendations to improve business processes to support client’s technology goals

Help verify that all requirements have been met by approving and validating test results

Testing point of sale (POS) pharmacy claims as required

Exercise your ability to use basic analytical or relational database software — such as Excel or SQL — to quantify the anticipated impact of work

What we're looking for

Three (3) or more years of experience in a relevant pharmacy business analyst or pharmacy technician position with 1+ or more years of Medicaid and Medicare experience preferred

Knowledge of computer programming concepts such as configuration, development, data conversion analysis and batch processing

Pharmacy Experience as a Pharmacy Technician or working for a PBM

Knowledge of drugs and drug file structures through FDB, Medispan, or Micromedex

Knowledge the pharmacy payer process/claims processing.

Experience working with drug file data or NCPDP guidelines

Knowledge of prior authorization processes and criteria preferred

Advanced knowledge in analytical software such as Microsoft Excel or SQL and other requirement-mapping tools such as Application Lifecycle Management (ALM) tools

Skills and Compentencies

Strong client communication skills translating client needs to actionable objectives

Strong analytical and business process re-engineering skills

Strong executive presence and communication skills to deliver messages to business leaders, clients and technical personnel

Good organization skills to balance work and prioritize tasks

Ability to work independently with minimal supervision

What you should expect in this role

Fully remote options from continental US locations only

Video cameras must be used during all interviews, as well as during the initial week of orientation

The deadline to submit applications for this posting is July 29, 2025

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#LI-SQL The pay range for this position is $51,900.00 - $74,200.00 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’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.