Manager, Clinical Pharmacy Operations

CareSource•Dayton, OH

5d•$113,000 - $197,700•Onsite

About The Position

The Manager, Clinical Pharmacy Operations is responsible for oversight of all Clinical Pharmacy activities ensuring consistency in delivery of services and achievement of utilization targets. This role involves assisting in the coordination and management of the pre-determination process for specialty pharmacy, developing integrated service delivery, and overseeing data and processes to maintain industry standards. The manager will also assist the Director in developing processes to manage appropriate utilization and assure appropriate payment for services, interact with providers and staff to manage benefits aligned with regulations, URAC and NCQA regulations and CareSource policies, and review and revise workflows to maximize efficiencies. Key responsibilities include monitoring productivity and utilization trends, overseeing CQI activities, ensuring audits and staff feedback occur regularly, and regularly reporting all specialty pharmacy data. The role also requires ensuring compliance with and reporting of all regulatory requirements, analyzing and formulating recommendations based on data, and maintaining and updating all departmental policies and procedures. The Manager will act as a liaison with other departments for research and intervention, empower staff to achieve goals, coach, develop, and motivate the team, and foster positive working relationships with internal departments and external providers.

Requirements

Bachelor of Arts or Bachelor of Science in health related field, science or math related field or equivalent work experience is required
Three to five years’ experience in Managed Care/Medicaid is required
Three to five years in Specialty Pharmacy Utilization is required
Intermediate proficiency level with Microsoft Outlook, Work, Excel, and PowerPoint
Experience in data analysis and trending
Knowledge of care management standards and practices
Communication skills
Management and prior supervisory skills
Ability to work independently and within a team environment
Attention to detail
Familiarity of the health care field
Critical listening and thinking skills
Training/teaching skills
Strategic management skills
Negotiation skills/experience
Proper grammar usage
Change resiliency
Technical writing skills
Time management skills
Proper phone etiquette
Customer service oriented
Decision making/problem solving skills
Leadership experience and skills
Unrestricted registered pharmacist (RPh) Licensure in state of practice is required

Nice To Haves

Degree in pharmacy (RPh) or Bachelor of Science in Nursing (BSN) is preferred
One to two years of experience in Case Management or home health care, is preferred

Responsibilities

Assist in coordination and management of the pre-determination process for specialty pharmacy
Assist in the development of integrated service delivery to members and oversee data and processes to maintain industry standards and practices
Assist the Director in developing processes to manage appropriate utilization and assure appropriate payment for services
Interact with providers and staff to manage benefits aligned with regulations, URAC and NCQA regulations and CareSource policies and vision
Review and revise workflows to maximize efficiencies
Monitor productivity and utilization trends
Oversee CQI activities and ensure audits and staff feedback occur at regular intervals
Regularly report all specialty pharmacy data
Ensure compliance with and reporting of all regulatory requirements
Analyze and formulate recommendations based on data
Maintain and update all departmental policies and procedures
Act as liaison with other departments to assist with research and intervention
Empower staff to achieve goals
Coach, develop, and motivate team
Foster positive working relationships with internal departments and external providers
Perform any other job related instructions as requested