Manager, Clinical Pharmacy Operations
Job Summary:
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.
Essential Functions:
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
Education and Experience:
Bachelor of Arts or Bachelor of Science in health related field, science or math related field or equivalent work experience is required
Degree in pharmacy (RPh) or Bachelor of Science in Nursing (BSN) is preferred
Three to five yearsā experience in Managed Care/Medicaid is required
Three to five years in Specialty Pharmacy Utilization is required
One to two years of experience in Case Management or home health care, is preferred
Competencies, Knowledge and Skills:
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
Licensure and Certification:
Unrestricted registered pharmacist (RPh) Licensure in state of practice is required
Working Conditions:
General office environment; may be required to sit or stand for extended periods of time
Compensation Range:
$113,000.00 - $197,700.00CareSource takes into consideration a combination of a candidateās education, training, and experience as well as the positionās scope and complexity, the discretion and latitude required for the role, and other external and internal data when establishing a salary level. In addition to base compensation, you may qualify for a bonus tied to company and individual performance. We are highly invested in every employeeās total well-being and offer a substantial and comprehensive total rewards package.
Compensation Type (hourly/salary):
Salary
Organization Level Competencies
Fostering a Collaborative Workplace Culture
Cultivate Partnerships
Develop Self and Others
Drive Execution
Influence Others
Pursue Personal Excellence
Understand the Business
This job description is not all inclusive. CareSource reserves the right to amend this job description at any time. CareSource is an Equal Opportunity Employer. We are dedicated to fostering an environment of belonging that welcomes and supports individuals of all backgrounds.
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Apply To This Job
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.
Essential Functions:
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
Education and Experience:
Bachelor of Arts or Bachelor of Science in health related field, science or math related field or equivalent work experience is required
Degree in pharmacy (RPh) or Bachelor of Science in Nursing (BSN) is preferred
Three to five yearsā experience in Managed Care/Medicaid is required
Three to five years in Specialty Pharmacy Utilization is required
One to two years of experience in Case Management or home health care, is preferred
Competencies, Knowledge and Skills:
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
Licensure and Certification:
Unrestricted registered pharmacist (RPh) Licensure in state of practice is required
Working Conditions:
General office environment; may be required to sit or stand for extended periods of time
Compensation Range:
$113,000.00 - $197,700.00CareSource takes into consideration a combination of a candidateās education, training, and experience as well as the positionās scope and complexity, the discretion and latitude required for the role, and other external and internal data when establishing a salary level. In addition to base compensation, you may qualify for a bonus tied to company and individual performance. We are highly invested in every employeeās total well-being and offer a substantial and comprehensive total rewards package.
Compensation Type (hourly/salary):
Salary
Organization Level Competencies
Fostering a Collaborative Workplace Culture
Cultivate Partnerships
Develop Self and Others
Drive Execution
Influence Others
Pursue Personal Excellence
Understand the Business
This job description is not all inclusive. CareSource reserves the right to amend this job description at any time. CareSource is an Equal Opportunity Employer. We are dedicated to fostering an environment of belonging that welcomes and supports individuals of all backgrounds.
#LI-JM1
Apply To This Job