Pharmacy Operations Manager

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Medical Review Institute of America, LLC

WebsiteLinkedInAll Job Openings

501 - 1000 employees

Founded 1983

⚕️ Healthcare Insurance

☁️ SaaS

Healthcare Insurance • SaaS • Data

Medical Review Institute of America, LLC is a company specializing in clinical and utilization review services. They offer a comprehensive suite of data-driven solutions, including prior authorization optimization, second opinions, and specialty drug reviews, aimed at ensuring the right care is delivered at the right time and in the right place. MRIoA provides services to health plans, pharmacy benefit managers, government entities, and self-insured employers, among others. They leverage technology and a network of professionals to streamline clinical decisions, enhance provider performance, and ensure compliance with regulatory requirements across all 50 states. Their tools and platforms are designed to optimize clinical reviews, reduce costs, and improve patient outcomes through evidence-based care pathways and telehealth solutions.

📋 Description

• 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

🎯 Requirements

• 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)

🏖️ Benefits

• 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