Lead and/or support high-visibility business projects impacting CHC drug UM operations
Serve as an SME on UM systems and operational workflows
Investigate complex escalations by validating true root cause
Analyze and interpret large datasets (claims, benefit files, UM outcomes)
Translate business strategy and compliance or contract requirements into clear operational requirements
Present solution options with risks, benefits, and tradeoffs
Support AHIP-related drug benefit and UM initiatives
Drive communication in a highly matrixed environment

Bachelor’s degree preferred or 10+ years of relevant drug prior authorization experience
Extensive knowledge of pharmacy and medical benefit UM operations and claims processing
Strong analytical skills with experience working with large datasets
Proven ability to lead complex initiatives and influence across matrixed teams
Clear, concise communication skills with the ability to present to senior leadership.

Senior Advisor, Pharmacy UM Strategy – Operations

Key skills