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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
ATS Keywords
✓ Tailor your resumeApplicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills & Tools
prior authorization reviewdrug product calculationsclaims adjudicationclinical criteria developmentoperational process improvementsKPI managementresource allocationtechnology implementationregulatory complianceaccreditation standards
Soft Skills
coachingmentoringactive listeningempathymultitaskingtime managementclear communicationflexibilityadaptabilityproblem-solving
Certifications
Bachelor’s degree in PharmacyDoctor of Pharmacy (PharmD)Active Pharmacist License