Pharmacy Operations Manager

🕒 5 dias atrás

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Medical Review Institute of America, LLC

SiteLinkedInTodas as Vagas

501 - 1000 funcionários

Fundada em 1983

⚕️ Seguro de Saúde

☁️ SaaS

Healthcare Insurance • SaaS • Data

O Medical Review Institute of America, LLC é uma empresa especializada em serviços de revisão clínica e de utilização. Eles oferecem um conjunto abrangente de soluções baseadas em dados, incluindo a otimização de autorizações prévias, segundas opiniões e revisões de medicamentos especializados, com o objetivo de garantir que o cuidado certo seja entregue no momento e lugar certos. A MRIoA fornece serviços a planos de saúde, administradores de benefícios de farmácias, entidades governamentais, e empregadores auto-segurados, entre outros. Eles utilizam tecnologia e uma rede de profissionais para simplificar decisões clínicas, melhorar o desempenho dos provedores e garantir conformidade com requisitos regulatórios em todos os 50 estados. Suas ferramentas e plataformas são projetadas para otimizar revisões clínicas, reduzir custos e melhorar resultados para pacientes através de padrões de cuidado baseados em evidências e soluções de telemedicina.

Descrição

• Manager-level position responsible for end-to-end operational oversight of pharmacy operations supporting both clinical and non-clinical functions • Accountable for workflow performance, team coordination, and execution across integrated operational models • Leads cross-functional teams responsible for case progression, clinical review support, and completion activities, ensuring alignment with quality, turnaround time, and productivity expectations • Partners with clinical leadership, quality, and operations teams to drive efficiency, reduce rework, and support scalable, high-performing operational workflows • Provide operational leadership for pharmacy operations workflows, including both clinical and non-clinical functions supporting IRO services (initial reviews and appeals) • Own the execution and performance of integrated pharmacy operations, ensuring alignment across case progression, clinical review support, and completion processes • Lead cross-functional teams to deliver against key operational metrics, including quality, turnaround time, productivity, and backlog management • Drive alignment between clinical and non-clinical workflows to ensure efficient case flow, minimize rework, and optimize resource utilization • Partner with clinical leadership, quality, and operations teams to ensure consistency in review practices, documentation standards, and workflow execution • Contribute to the ongoing design, refinement, and standardization of operational workflows to support scalability and performance improvement • Develop team capability through coaching, performance management, and workforce planning across both clinical and non-clinical staff • Identify operational risks, gaps, and inefficiencies, and implement solutions to improve performance and service delivery • Lead day-to-day operations of pharmacy workflows, ensuring efficient case progression across clinical and non-clinical functions • Own performance outcomes for assigned operations, including quality, turnaround time, productivity, and backlog management • Monitor and manage workflow distribution, capacity, and staffing to ensure alignment with volume demands and service level expectations • Ensure effective coordination between clinical and non-clinical functions to support seamless case flow and minimize delays or rework • Identify and resolve operational bottlenecks, inefficiencies, and breakdowns in workflow execution • Establish and maintain performance standards, ensuring accountability at both individual and team levels • Provide direct leadership to team members, including coaching, performance management, and development of both clinical and non-clinical staff • Partner with quality and clinical leadership to ensure consistency in review practices, documentation, and adherence to internal and external standards • Support implementation and stabilization of new workflows, processes, and operational changes to improve efficiency and scalability • Analyze operational data and performance trends to identify opportunities for improvement and drive informed decision-making • Ensure readiness and operational alignment for new clients, products, or workflow changes impacting pharmacy operations • Maintain effective communication with cross-functional partners to ensure alignment on priorities, risks, and performance outcomes • Perform other duties as required to support operational performance and business needs

🎯 Requisitos

• Minimum of 2–3 years of supervisory or leadership experience in healthcare operations, managed care, or a related environment • Experience supporting clinical review, quality auditing, completion, or similar operational workflows preferred • Clinical experience in utilization review, clinical quality auditing, or related healthcare review functions preferred • Strong understanding of healthcare operations, including clinical review workflows, case progression, and operational support functions within pharmacy operations • Demonstrated leadership experience managing both clinical and/or non-clinical teams in a healthcare or managed care environment • Ability to manage end-to-end workflows, including coordination between clinical and non-clinical functions to drive efficient case flow • Strong operational and problem-solving skills, with the ability to identify bottlenecks, resolve workflow issues, and improve performance • Experience managing performance metrics, including quality, turnaround time, productivity, and backlog • Ability to work in a fast-paced environment, managing multiple priorities and shifting demands • Strong communication skills, with the ability to collaborate effectively across clinical, quality, and operations teams • Strong organizational skills and attention to detail • Working knowledge of medical terminology and healthcare processes • Knowledge of regulatory, compliance, and accreditation requirements applicable to healthcare operations • Proficiency in standard business tools (Microsoft Office Suite)

🏖️ Benefícios

• healthcare, vision and dental insurance • a generous 401k match • paid vacation • personal time • holidays • Growth and training opportunities • A team atmosphere with fun events and prizes scheduled throughout the year