Manager, Clinical Patient Access - BioPlus Specialty Pharmacy

Elevance Health • San Antonio, TX

1d • Onsite

About The Position

The Manager – Clinical Patient Access is responsible for performing functions that involve planning for, managing and providing clinical oversight of the Patient Access function, involving initial intake, insurance benefits investigation, and authorization requirements, cultivating an environment of outstanding customer service, as the voice of the company in all interactions with the referral sources and patients.

Requirements

• Requires a Doctorate Degree in Pharmacology and minimum of 3 years pharmacy leadership experience; or any combination of education and experience, which would provide an equivalent background.
• Requires a current, valid, active unrestricted Registered Pharmacist license.

Nice To Haves

• Specialty pharmacy experience.
• Prior authorization, claims, and benefit investigation experience.

Responsibilities

• Oversee the processing of new patients’ referrals, insurance benefit investigation and verifications, and procurement of authorizations based on clinical criteria provided by the prescriber.
• Train and provide clinical refreshers to the regarding drug therapy, treatment management and disease states as new indications enter the market.
• Participate in pharmaceutical launches, quarterly business reviews and enhanced quality calls with our external partners.
• Resolve clinical escalations presented by either the prescriber, payer, patient or external partner.
• Ensure that the clinical integrity of the prior authorization, appeal and denial process and procedures.
• Monitor results to evaluate compliance with quality and productivity expectations and identify opportunities for improving results.
• Hires, trains, coaches, counsels, and evaluates performance of direct reports.

Benefits

• We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few.

What This Job Offers

• Job Type: Full-time
• Career Level: Manager
• Education Level: Ph.D. or professional degree