Manager of Pharmacy Prior Authorizations

Summary/Position Objectives:
The Manager of Pharmacy Prior Authorizations is responsible for the ongoing management of the pharmacy prior authorization unit, including management of the data systems, human resource management of staff and supervisors, budget compliance, ongoing review and refinement of policies and procedures, processing of requests for pharmacy prior authorizations, data management, development, implementation and evaluation of process and service improvements, as well as monitoring and maintaining service levels and quality of service to the customer in accordance with established guidelines. Functions as a liaison with other department staff members to expedite business operations, assists in organizational audits and ensures compliance with the appropriate regulatory and accrediting agencies.

Responsibilities:
Essential Functions:
Effectively manages the daily operations of the Pharmacy Prior Authorization unit, including the employee selection process, development of staff and succession planning.
Continually evaluates and monitors the effectiveness and efficiency of pharmacy prior authorization activities through analysis and the use of relevant data and management reports. This includes but is not limited to weekly review of denied requests, overturned requests, etc. and identification and reporting of trends.
Consistently monitors pharmacy prior authorization performance statistics, including telephone service levels and customer service, as well as other service indicators. Ensures that telephone performance standards and turn around times for processing pharmacy prior authorization requests are consistently met for each SAI Plan.
Participates in the development and ongoing maintenance of pharmacy prior authorization Business Standards of Practice, Policies and Procedures and desktops. Recommends policy, procedure, and operational changes to optimize pharmacy prior authorization functions.
Leads the development of and ongoing improvements to the pharmacy prior authorization database.
Develops, implements and manages employee monitoring programs to ensure compliance with and consistent application of established clinical protocols used to determine medical necessity.
Develops financial, personnel, administrative, and training functions to ensure adequate systems and staffing infrastructure and support; ensures personnel have current training; provide updated job descriptions and performance reviews.
Formulates and submits operational budgets as requested in conjunction with fiscal year parameters. Monitor expenses within approved budget and participate in budget development and forecasting activities.
Ensures compliance with Plan Sponsors and regulatory requirements for all lines of business, including participating in any external quality review activities.
Identifies and reports issues that may result in a grievance or appeal to ensure appropriate awareness to the department director.
Serves as a resource for implementation of new programs, projects and products.
Maintains strict confidentiality in regards to all member, provider, contract service and corporate information.

ABOUT SCHALLER ANDERSON:

Schaller Anderson administers Medicaid and employer self-funded health plans, and manages behavioral health plans. The company’s suite of services includes member services; provider services; claims processing; information services; financial reporting and analysis; medical management; and grievances and appeals services. Schaller Anderson has also been engaged in several consulting projects for states, health plans and providers. Schaller Anderson and its affiliates have 1,400+ employees nationwide and administer health plans with over 1.6 million members. Recently, the Initiative for a Competitive Inner City and Inc. magazine named Schaller Anderson to the Inner City 100, a list that recognizes the fastest-growing companies in America’s core urban areas. Schaller Anderson placed eighth among 5,000 entries in the Inner City 100 competition and was the only health care management company in the top 10.

The VISION of Schaller Anderson, Inc. is to be recognized as the nation’s foremost managed care resource by providing the highest value management and consulting services throughout the health care continuum.


BENEFITS:

Schaller Anderson team members are provided with countless opportunities to make a real difference and the following compensation/benefits:

* Competitive compensation DOE
* Medical, Dental and Vision insurance
* Employee Assistance Program
* Flexible spending accounts
* On-site fitness center (Phoenix headquarters only)
* Life insurance and accidental death and dismemberment insurance
* Short-term and long-term disability
* Paid holidays, paid time off/paid time off reserve
* 401(k) and profit sharing
* Tuition reimbursement
REQUIREMENTS
Knowledge and Skills:
Incumbent must have advanced and meticulous organization and coordination, and the ability to prioritize multiple tasks. Excellent oral and written communication skills are necessary. Working knowledge of pharmacy prior authorization and drug classes is required. Thorough and working knowledge of Medicaid and Medicare regulatory requirements is required. The ability to establish and maintain constructive relationships with diverse members, management, employees, and vendors, and the ability to use advanced reason to define problems, collect data, establish fact, draw valid conclusions, and design, implement, and manage appropriate resolution are required. The ability to successfully utilize Microsoft Office suite and common computer and office hardware functions and perform counseling, planning, and training, while managing various staffing patterns is necessary.

Education and Work Experience:
Bachelor of Science and/or equivalent experience required.
Minimum of 4 years experience in a pharmacy prior authorization unit. Incumbent must have a minimum of two years managed health care experience.
Minimum of 5 years management experience
Must be able to successfully access employee strength and developmental needs
Demonstrated ability to manage, coach and mentor staff
Demonstrated working knowledge of drug classes, step therapies, etc.
ACD call tracking and performance monitoring preferred. Strong knowledge and understanding of telephone technology and process improvement.
Working knowledge of Medicare and Medicaid, in particular Medicare Part D (pharmacy), and Pharmacy Benefits Manager (PBM) highly desired.
Ability to manage data, design and implement reporting and performance data audits. Must have 2 years experience with data analysis and report preparation
Advanced problem solving skills, the ability to learn quickly, strong organizational skills and flexibility are required
Excellent oral and written communication skills and the ability to prioritize and complete multiple tasks concurrently are necessary
Working knowledge of Microsoft Office programs, including Word, Excel, Access and Project.