Manager, Clinical Pharmacy Operations

Role Overview

• Responsible for oversight of all Clinical Pharmacy activities ensuring consistency in delivery of services and achievement of utilization targets
• 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

Requirements

• 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 years’ 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
• Intermediate proficiency level with Microsoft Outlook, Work, Excel, and PowerPoint
• Experience in data analysis and trending
• Knowledge of care management standards and practices
• Critical listening and thinking skills
• Proper grammar usage

Benefits

• Comprehensive total rewards package
• Bonus tied to company and individual performance