Senior Manager, Medicare Utilization Management, Pharmacist
Capital Rx
full-time
Posted on:
Location Type: Remote
Location: United States
Visit company websiteExplore more
Salary
💰 $150,000 - $160,000 per year
Job Level
About the role
- Manage and optimize Medicare prior authorization and appeals processes
- Ensure compliance with CMS guidelines while overseeing a dynamic team
- Create and maintain policies, procedures, and job aids
- Manage contracts with regulatory vendors
- Oversee member and provider communications
- Collaborate with internal stakeholders to support clinical operations
- Drive team performance, provide training, and ensure adherence to compliance standards
- Participate in goal setting and evaluate team performance
- Generate and deliver reports on prior authorization
Requirements
- 2+ years of Medicare PA leadership experience required
- Experience with managing large remote teams preferred
- Medicare implementation experience preferred
- 4+ years of experience at a PBM or health plan preferred
- Active, unrestricted, pharmacist license required
- Exhibit strong written communication and oral presentation skills
- Proficient in Microsoft office Suite with an emphasis on PowerPoint and Excel
- Self-starter with the ability to work in a fast-paced environment with shifting priorities
Benefits
- Health insurance
- Flexible work arrangements
Applicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills & Tools
Medicare prior authorizationMedicare appeals processespolicy creationprocedure maintenancecontract managementreport generationteam performance evaluationtraining provision
Soft Skills
strong written communicationoral presentationself-starterability to work in fast-paced environmentadaptability to shifting priorities
Certifications
active pharmacist license