Pharmacy Operations Manager

Job description

Oversees the day-to-day operation of the Prior Authorization Department and staff assigned to ensure all contract requirements and business initiatives are completed successfully and timely. Works closely with the CMO and Director of Pharmacy to ensure that the Pharmacy Department is a highly functioning quality department, characterized by teamwork, cooperation, efficiency, innovation and excellence. Serves as a role model and mentor for assigned staff - Implements and maintains an effective prior authorization program that meets the timeliness for the Medicaid and Medicare lines of business. This includes timeliness of denials, denial notifications, both verbal and written, and appropriate documentation and logs. - Conducts both monthly and quarterly audits in PA to include routine data entry, denials, and closure of authorization. - Works with Diretor of Pharmacy in oversight responsibilies of PBMs. This includes working with staff to analyze PBM reports to ensure correct adjustication of claims. - Ensures standardization and consistency in practices, procedures and workflow to improve efficiency and quality. - Monitors and implements productivity standards and takes necessary a...