Manager, Pharmacy Clinical Operations (Clinical Configuration)

Elevance Health • Cincinnati, OH

21h • Hybrid

About The Position

The Manager, Pharmacy Clinical Operations (Clinical Configuration) responsible for developing and implementing clinical pharmacy programs to promote quality and cost-effective drug utilization.

Requirements

• Requires BA/BS in Pharmacy.
• Minimum of 4 years of experience as a pharmacist in a clinical setting; or any combination of education and experience, which would provide an equivalent background.
• Requires a registered pharmacist.
• Must possess an active unrestricted state license to practice pharmacy as a Registered Pharmacist (RPh).
• Unless expressly allowed by state or federal law, or regulation, must be located in a state or territory of the United States when conducting utilization review or an appeals consideration and cannot be located on a US military base, vessel or any embassy located in or outside of the United States.
• For URAC accredited areas, the following professional competencies apply: Associates in this role are expected to have strong oral, written and interpersonal communication skills, problem-solving skills, facilitation skills, and analytical skills.

Responsibilities

• Oversees pharmacist and pharmacy intern associates developing and configuring prior authorization decision trees in the PA workflow tool.
• Oversees associate performance and quality assurance of prior authorization decision trees within the PA workflow tool.
• Provides clinical consulting services to internal partners.
• Assists in implementing clinical programs within the prior authorization space.
• Assists in the development of new clinical products.
• Oversees the Prior Authorization Center.
• Implements new prior authorization programs.
• Manages clinical pharmacy operations and staff to ensure clients' objectives and deliverables are met.
• Oversees departmental processes, policies and procedures, training, and communication.
• Reports and analyzes prior authorization program trends.
• Ensures achievement of department goals and objectives.
• Hires, trains, coaches, counsels, and evaluates performance of direct reports.
• Provides clinical consulting services to client and implements clinical information and education programs.
• Assists in developing formularies.
• Performs drug utilization analyses.
• Participates in and presents to Pharmacy and Therapeutics (P&T) committee meetings and management of client formulary.

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
• Number of Employees: 5,001-10,000 employees