Prior Authorization Supervisor

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Shields Health Solutions

WebsiteLinkedInAll Job Openings

501 - 1000 employees

Founded 2011

⚕️ Healthcare Insurance

💊 Pharmaceuticals

☁️ SaaS

Healthcare Insurance • Pharmaceuticals • SaaS

Shields Health Solutions is a company that specializes in providing integrated specialty pharmacy solutions. They focus on eliminating disruptions in patient care by offering a comprehensive model that bridges the gap between patients and the specialty medications they need. Shields Health Solutions partners with healthcare providers and drug manufacturers to optimize the impact of specialty pharmacy services. Their approach leverages a clinical model, expert care teams, and a proprietary technology platform to improve patient access to specialty drugs, while reducing the overall cost of care. Shields Health Solutions aims to enhance patient experiences and health outcomes through their innovative solutions in specialty pharmacy integration.

📋 Description

• Directly lead and manage a team of Patient Support Associates to ensure medication adherence through refill management OR timely and accurate prior authorization and financial assistance support to assist patients in obtaining medication. • Proactively manage support in assigned hospitals and/or clinics to ensure patients receive medications on-time • Lead and manage a Patient Support team to ensure all service level goals are met and patients receive the highest quality care • Manage all aspects of ADP, Paid Time Off (PTO), and Time Reports for team members • Complete audits of team in supported systems required to ensure efficient workflow • Manage responsiveness to new request in supported systems • Provide front-line supervision and ongoing coaching and performance management to Patient Support team • Monitor and acting on all forms of communications between the Patient Support team and other clinical teams as needed • Work with on-site management at hospital partners for any collaboration calls, such as quarterly calls, kick off calls, as needed calls • Patient Support team meetings: create agendas, run meeting, follow-up • Hospital Management meeting: calls with on-site manager to review current status, identify areas for improvement, and areas of success • Record keeping/notes of all collaboration calls and team meetings • Provide guidance/assistance/troubleshooting in daily tasks for Patient Support team members as requested by team • Review and address any concerns with Patient Support team, and hospital partners as needed • Establish efficient workflows between the Patient Support team and liaison team via collaboration with clinical integration team and on-site managers. • Provide insight to various teams across company for growth and development opportunities as needed • Work with various teams for special projects • Report on hiring needs based on implementation roll outs • Assist in interviewing, and onboarding new team members • Coordinate access requests for new hires • Coordinate training with Clinical Training Team • Absorb overflow work in times of short staffing or excess workload • Investigate research needed for data analytics team, contracting team as needed • Manage on site pharmacy relations and workflows through some/all of the following: reversal of claims, delivery slips, coordination of care, phone calls • Use discretion and maintain confidentiality of highly sensitive and private data. • Ability to lead, manage, and motivate team members that are in both remote working environments and/or at on-site Shields hub locations

🎯 Requirements

• Required 3+ years of pharmacy technician experience (3-5+ years’ experience preferred in Specialty Pharmacy) • Strongly preferred leadership experience (i.e. Team Lead or equivalent type role or experience where you have led other team members even if they do not directly report to you) • Required Licensure/Certification: registered with the State of employment and also nationally certified as a CPhT

🏖️ Benefits

• Health insurance • Paid Time Off (PTO) • Professional development opportunities