Pharmacy Operations Manager

Conifer Health Solutions • Goodyear, AZ

2d

About The Position

Oversees the day-to-day operation of the Prior Authorization Department and staff assigned to ensure all contract requirements and business initiatives are completed successfully and timely. Works closely with the CMO and Director of Pharmacy to ensure that the Pharmacy Department is a highly functioning quality department, characterized by teamwork, cooperation, efficiency, innovation and excellence. Serves as a role model and mentor for assigned staff.

Requirements

• Previous prior-authorization experience in a managed care organization.
• Good communication, organizational, and PC skills required.

Nice To Haves

• Demonstrated experience managing staff.
• Demonstrated ability to work in fast pace, multi-tasking team environment while meeting deadlines.
• Highly skilled in leading significant change efforts and in building strong partnerships with business-line executives.
• Proficiency in the management of time, flexibility, and influencing colleagues to meet demanding project timelines.
• Developed ability to use various PC software programs: Microsoft Word, Excel, Access, and PowerPoint.
• Previous project management desired.
• Strong verbal and written communication skills and ability to form cross functional partnerships to accomplish goals.
• Strong coaching and interpersonal skills.
• Ability to cultivate a strong internal culture designed around collaboration, feedback, motivation and accountability

Responsibilities

• Implements and maintains an effective prior authorization program that meets the timeliness for the Medicaid and Medicare lines of business. This includes timeliness of denials, denial notifications, both verbal and written, and appropriate documentation and logs.
• Conducts both monthly and quarterly audits in PA to include routine data entry, denials, and closure of authorization.
• Works with Director of Pharmacy in oversight responsibilities of PBMs. This includes working with staff to analyze PBM reports to ensure correct adjudication of claims.
• Ensures standardization and consistency in practices, procedures and workflow to improve efficiency and quality.
• Monitors and implements productivity standards and takes necessary action when standards are consistently not met.
• Works with Director of Pharmacy to ensure PA department receives compliance in all assigned areas on reviews for Medicaid and Medicare.
• Assist in the development and implementation of CAPs for both Medicaid and Medicare when applicable.
• Other related job tasks or responsibilities as assigned

What This Job Offers

• Career Level: Manager
• Education Level: No Education Listed
• Number of Employees: 1,001-5,000 employees