Manager, Clinical Pharmacy Operations

Job Summary:

The Manager, Clinical Pharmacy Operations is responsible for oversight of all Clinical Pharmacy activities ensuring consistency in delivery of services and achievement of utilization targets.

Essential Functions:

• Assist in coordination and management of the pre-determination process for specialty pharmacy
• Assist in the development of integrated service delivery to members and oversee data and processes to maintain industry standards and practices
• Assist the Director in developing processes to manage appropriate utilization and assure appropriate payment for services
• Interact with providers and staff to manage benefits aligned with regulations, URAC and NCQA regulations and CareSource policies and vision
• Review and revise workflows to maximize efficiencies.
• Monitor productivity and utilization trends
• Oversee CQI activities and ensure audits and staff feedback occur at regular intervals
• Regularly report all specialty pharmacy data
• Ensure compliance with and reporting of all regulatory requirements
• Analyze and formulate recommendations based on data
• Maintain and update all departmental policies and procedures
• Act as liaison with other departments to assist with research and intervention
• Empower staff to achieve goals
• Coach, develop, and motivate team
• Foster positive working relationships with internal departments and external providers
• Perform any other job related instructions as requested

Education and Experience:

• Bachelor of Arts or Bachelor of Science in health related field, science or math related field or equivalent work experience is required
• Degree in pharmacy (RPh) or Bachelor of Science in Nursing (BSN) is preferred
• Three to five  years’ experience in Managed Care/Medicaid is required
• Three to five years in Specialty Pharmacy Utilization is required
• One to two years of experience in Case Management or home health care, is preferred

Competencies, Knowledge and Skills:

• Intermediate proficiency level with Microsoft Outlook, Work, Excel, and PowerPoint
• Experience in data analysis and trending
• Knowledge of care management standards and practices
• Communication skills
• Management and prior supervisory skills
• Ability to work independently and within a team environment
• Attention to detail
• Familiarity of the health care field
• Critical listening and thinking skills
• Training/teaching skills
• Strategic management skills
• Negotiation skills/experience
• Proper grammar usage
• Change resiliency
• Technical writing skills
• Time management skills
• Proper phone etiquette
• Customer service oriented
• Decision making/problem solving skills
• Leadership experience and skills

Licensure and Certification:

• Unrestricted registered pharmacist (RPh) Licensure in state of practice is required

Working Conditions:

• General office environment; may be required to sit or stand for extended periods of time

Compensation Range:

CareSource takes into consideration a combination of a candidate’s education, training, and experience as well as the position’s scope and complexity, the discretion and latitude required for the role, and other external and internal data when establishing a salary level. In addition to base compensation, you may qualify for a bonus tied to company and individual performance. We are highly invested in every employee’s total well-being and offer a substantial and comprehensive total rewards package.

Compensation Type (hourly/salary):

Organization Level Competencies

• Fostering a Collaborative Workplace Culture

• Cultivate Partnerships

• Develop Self and Others

• Drive Execution

• Influence Others

• Pursue Personal Excellence

• Understand the Business