Senior Manager, Prior Authorizations – Pharmacist

🕒 il y a 2 mois

🏰 Missouri – Distant

🏰 Missouri – Remote

💵 $122 200 - $174 600 / an

⏰ Temps Plein

🟠 Senior

👔 Manager

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Gainwell Technologies

Site WebLinkedInTous les Emplois

10 000+ employés

⚕️ Assurance santé

💰 Grant en 2023-06

Healthcare Insurance • Human Services • Healthcare

Gainwell Technologies est le principal fournisseur national de solutions numériques et en mode cloud dans l'écosystème des services sociaux et de la santé publique. Avec une approche axée sur les missions, Gainwell sert des clients dans les 50 états américains, en se concentrant sur l'amélioration des résultats de santé et la fourniture d'expériences intuitives centrées sur l'humain. Leur gamme complète de solutions comprend la modernisation de l'entreprise Medicaid, l'analyse de données, les services aux prestataires et les solutions pharmaceutiques, toutes conçues pour faire progresser l'avenir des soins de santé et améliorer le bien-être communautaire.

Description

• Oversight of prior authorization, pharmacist appeals, and peer-to-peer DLP creation, modification, training, and implementation • Collaboration with internal leaders/teams including, but not limited to: Claims, Grievance and Appeals, Clinical, Quality Assurance, Network, and Training • Evaluate drug and drug class reviews following evidence-based research and processes widely accepted by the medical community • Maintain up-to-date knowledge of medications, drugs, and prescribing practices; advise Gainwell leaders based on your knowledge and expertise • Help write consultation and intervention scripts to support continuous improvement and quality improvement processes • Assist Gainwell clinical leadership in reviewing clinical criteria and Preferred Drug List (PDL) recommendations used to make coverage and PDL placement decisions

🎯 Exigences

• 5 or more years of experience leading a team of pharmacists managing prior authorizations • Must hold an active pharmacist license in the state of Missouri • Prior management experience (non-retail) is required • Experience with pharmacy claims, clinical operations, medication pricing methodologies, NCPDP standards, electronic prior authorizations, financial management, and managed care statutes • Knowledge of current research and best practices related to specialty medications • Analytical and research expertise to conduct drug class and clinical reviews involving prescribing behavior • Strong written, oral, and clinical communication skills to collaborate with physicians, prescribers, pharmacists, and Gainwell leadership • A caring people leader who understands their role on a team and can effectively delegate tasks

🏖️ Avantages

• Comprehensive health benefits • 401(k) employer match • Flexible vacation policy • Educational assistance • Leadership and technical development academies