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Manager, Clinical Pharmacists (Prior Authorization)

Company: Magellan Health
Location: Rancho Cordova
Posted on: October 9, 2021

Job Description:

Oversees day-to-day operations of a team of call-center pharmacists to ensure department objectives and contractual service levels are met. Ensures adherence to standard operating procedures. Triages client and internal requests to resource assignment. Responsible for staff and schedules.

  • Manages the prior authorization program and monitors adherence to client's established clinical criteria. 
  • Manages appeal and physician resources, follows contractual obligations, maintains National Committee for Quality Assurance (NCQA) accreditation, maintains Utilization Review Accreditation Commission (URAC) accreditation, and follows State and Federal regulations.
  • Manages staff resources, resource allocation, and staff schedules to ensure adequate work coverage. Regularly communicates necessary information including personnel relations activity including employment, termination, performance reviews, salary reviews and disciplinary actions. 
  • Implements quality assurance reviews consistent with corporate QA programs. 
  • Ensures annual and corporate training requirements are complete.
  • Manages and handles new client implementations, program additions, and new client bid requests.
  • Implements QA process and inter-rater reliability testing to staff.
  • Mediates client escalated concerns, issues, and complaints.
  • Assists account team executives with client issues.
  • Identifies gaps which include IT systems, phones, edits and operational procedures, recommends modifications and improvements. 
  • Provides end-user input during meetings to strengthen systems and unify internal clinical criteria.
  • Analyzes daily, weekly, and monthly statistical reports and makes appropriate recommendations and forecasts regarding call volume and staff scheduling.
  • Provides input into the departmental budget.
  • Potentially makes outbound or takes inbound telephone calls to assist in various aspects of patient care and/or product distribution to/from practitioners, members, and pharmacies.
  • Takes calls including, but not limited to, comprehensive medication reviews, targeted medication reviews, call to practitioners about product awareness, and prior authorizations.

#LI-PA1

Other Job Requirements

Responsibilities

  • Current unrestricted state license required.
  • Demonstrated customer service and analytical skills.
  • Ability to use standard corporate software packages and corporate applications.
  • 5+ years' pharmacy experience required.
  • years' supervisory experience required.
  • Previous experience in managed health care or Pharmacy Benefit Management environment preferred.
  • Call center experience preferred.

General Job Information

Title

Manager, Clinical Pharmacists (Prior Authorization)

Grade

30

Work Experience

Management/Leadership, Pharmacy

Education

Bachelors: Pharmacy (Required), PharmD: Pharmacy

License and Certifications - Required

RPH - Registered Pharmacist - Pharmacy

License and Certifications - Preferred

PharmD - Doctor Of Pharmacy, State Licensure - Pharmacy

Magellan Health, Inc. is proud to be an Equal Opportunity Employer and a Tobacco-free workplace. EOE/M/F/Vet/Disabled.
Every employee must understand, comply with and attest to the security responsibilities and security controls unique to their
position; and comply with all applicable legal, regulatory, and contractual requirements and internal policies and procedures.

Keywords: Magellan Health, Rancho Cordova , Manager, Clinical Pharmacists (Prior Authorization), Other , Rancho Cordova, California

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