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:

$113,000.00 - $197,700.00

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):

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

This job description is not all inclusive. CareSource reserves the right to amend this job description at any time. CareSource is an Equal Opportunity Employer. We are dedicated to fostering an environment of belonging that welcomes and supports individuals of all backgrounds.

#LI-JM1