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ATS Keywords
Tailor your resumeApplicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills
prior authorization reviewdrug product calculationsclaims adjudicationclinical criteria developmentoperational process improvementsKPI managementresource allocationtechnology implementationregulatory complianceaccreditation standards
Soft Skills
coachingmentoringactive listeningempathymultitaskingtime managementclear communicationflexibilityadaptabilityproblem-solving
Tools & Technologies
MacMS OfficeG-Suite
Certifications & Qualifications
Bachelor’s degree in PharmacyDoctor of Pharmacy (PharmD)Active Pharmacist License
Industry Keywords
health planpharmacy benefit managerERISAACAMedicareURACNCQA
About the role
Key responsibilities & impact- Directly manage, coach, and mentor a team of prior authorization Pharmacists
- Responsible for driving and maintaining regulatory, compliance, and accreditation standards on the clinical review team
- Recruit and hire new team members
- Lead training and onboarding for all new team members
- Provide day-to-day supervision, support, and escalation path for Pharmacists on your team
- Manage team to meet target KPIs associated with our operating model
- Ensure efficient allocation of operations center resources and maintain high performance standards
- Identify and drive areas for operational process improvements to support scale
- Cross-functional collaboration with other departments including troubleshooting eligibility questions, claims adjudication, and benefit designs
- Motivates Pharmacist growth and performance through coaching interactions
- Drive quality member experiences by ensuring Clinical Review team policy and procedures are adhered to
- Responsible for scheduling to drive consistent capacity
- Responsible for execution of goals, and objectives of direct reports.
- Collaborate with Pharmacists within the Pharmacy and Therapeutics Committee process and participate in development of clinical criteria for medications requiring prior authorization
- Work with cross functional teams to further SmithRx’s mission, vision, values and goals
- Identify current process gaps and solve them using technology, process and people
- When new technology is delivered service as a change champion and improve processes to scale the business and drive efficiencies
Requirements
What you’ll need- 5+ years of health plan or pharmacy benefit manager experience, specifically involved in prior authorization review
- 3-5+ years of management experience required
- Familiarity with various regulatory (ERISA, ACA, Medicare) and accreditation requirements (URAC, NCQA)
- Proficiency in Mac, MS Office, G-Suite required
- Active listening, conversational speaking skills, with a high degree of empathy
- Self-starter with ability to multitask, prioritize and manage time effectively
- Ability to communicate clearly, present complex information to members, clients, pharmacies, providers, and other teams internally
- Ability to work accurately within protocols and follow appropriate escalation pathways for unique situations or where clarification is needed.
- Flexibility and ability to adapt to changes and updates to technology, processes and protocols
- Demonstrate accurate drug product/dose calculations for appropriate claim adjudication and knowledge of general pharmacy and drug product information for the prescription filling process
- Bachelor’s degree in Pharmacy or Doctor of Pharmacy (PharmD) required
- Active Pharmacist License required.
Benefits
Comp & perks- Highly competitive wellness benefits including Medical, Pharmacy, Dental, Vision, and Life Insurance and AD&D Insurance
- Flexible Spending Benefits
- 401(k) Retirement Savings Program
- Short-term and long-term disability
- Discretionary Paid Time Off
- Paid Company Holidays
- Wellness Benefits
- Commuter Benefits
- Paid Parental Leave benefits
- Employee Assistance Program (EAP)
- Well-stocked kitchen in office locations
- Professional development and training opportunities