Pharmacy Clinical Services Supervisor

Utah Retirement Systems•Salt Lake City, UT

6d•Hybrid

About The Position

The Pharmacy Clinical Services Supervisor leads the day-to-day operations of PEHP’s Pharmacy Clinical Services team in support of pharmacy cost-saving initiatives and respectful, accurate service to members and providers. The position performs complex first-line supervisory duties, including coordinating workflows, monitoring calls, and resolving high-level issues involving pharmacy customer service, preauthorization, and benefit interpretation. The role requires a thorough understanding of PEHP pharmacy benefits and preauthorization requirements, sound judgment, and strong management, organizational, communication, and conflict-resolution skills. The Supervisor develops and coaches team members, oversees training and quality control, monitors productivity, and helps ensure deadlines and responsibilities are met. The role also advocates for members, addresses complex pharmacy claim and enrollment issues, supports specialists during staffing shortages or peak workloads, coordinates benefit updates, oversees coordination-of-benefits claim processing, and recommends and implements procedures under the direction of the Member and Provider Services Director. The position maintains confidentiality and regular, reliable attendance, and performs other related duties as assigned.

Requirements

High school diploma and four years of progressively responsible experience performing pharmacy administrative and technical duties, or an equivalent combination of education and experience.
Current licensure as a Certified Pharmacy Technician in the State of Utah.
Working knowledge of office management systems for alphabetic and numeric record keeping, healthcare information systems, pharmacy software, electronic billing procedures, personal computer operations, Microsoft Office Suite, and 10-key.
Advanced knowledge of medical, dental, pharmaceutical, and Medicare Supplement claims adjudication policies, procedures, and processes; customer service; claims review; healthcare coding; enrollment; basic medical terminology; pharmacy adjudication; and drug usage, dosage, definitions, and codes.
Working knowledge of intermediate mathematics involving the metric system for calculating drug dosages related to pharmacy and medical claims.
Excellent telephone etiquette, public relations, interpersonal communication, negotiation, and verbal and written communication skills.
Ability to establish and maintain effective working relationships with professionals, executives, department heads, coworkers, and the public.
Ability to analyze escalated issues and recommend actions related to pharmacy claim functions.
Ability to multitask, prepare technical reports and documents, document information accurately, supervise and motivate, train coworkers, follow instructions and organized routines, prioritize work, meet deadlines, and follow through on assignments.
Ability to manage workload and deadline stress, handle difficult or irate phone calls, and work both independently and as part of a team.
Demonstrate judgment, high integrity, and personal values consistent with URS values.

Nice To Haves

Certification Professional Coder (CPC) certification.
Specific experience in claims processing, pharmacy software applications, electronic billing procedures, and PEHP.

Responsibilities

Make recommendations regarding worker performance, retention, advancement, discipline, and discharge, and participate in recruitment and selection of new hires.
Advocate for members by resolving pharmacy claim, enrollment, benefit interpretation, preauthorization, and coordination-of-benefits issues.
Ensure team deadlines and responsibilities are met; develop team members, support goal achievement, welcome new employees, and promote a team atmosphere.
Supervise training, set employee goals, coach and delegate assignments, coordinate special training, maintain quality control, and establish timely priorities.
Supervise the daily operations and workflow of the Pharmacy Clinical Services team.
Communicate pharmacy benefits, prior authorization decisions, and appeal decisions verbally and in writing.
Back up Pharmacy Clinical Services Specialists as needed, including handling phone calls, reviewing prior authorizations, managing pharmacy workbaskets, and carrying out other daily operational duties.
Coordinate with the Pharmacy Program Supervisor to communicate new or terminated benefits and program changes to the team and other departments as applicable.
Identify and resolve complex non-clinical issues and act as a liaison between Pharmacy Clinical Services and pharmacy leadership.
Oversee processing of coordination-of-benefits claims using the contracted Pharmacy Benefit Management system.
Maintain daily, weekly, monthly, and quarterly productivity reports, including preauthorization and appeal counts, call volume, quality audits, and daily work activities.
Assist with random audits of phone calls and preauthorizations to assess customer service, performance, and accuracy.
Recommend and implement procedures under the direction of the Member and Provider Services Director.
Assist URS Retirement and PEHP employees with pharmacy claims adjudication, benefit, preauthorization, appeal, and claims-status questions.
Maintain regular and reliable attendance and strict confidentiality.
Perform other related duties as assigned.