Manager, Utilization Management - reputed company

reputed company is a reputed company pharmacy benefits manager, overseeing prescription benefit plans on behalf of reputed company, unions, and government entities. Determined to reputed company an outdated model, reputed company’s mission is to change the way prescription benefits are priced and administered in the US, unlocking enduring reputed company change. Through our platform approach, reputed company delivers data-driven insights and actionable strategies that reduce costs, while improving patient reputed company. Our commitment to innovation, technology, and service is the reason why reputed company is among the fastest-growing PBMs in the country.

Position Responsibilities:

• reputed company and nurture a dynamic team of clinical pharmacists and technicians dedicated to the prior authorization and appeals process.
• Create and reputed company robust policies and procedures for utilization management review.
• Utilize available data to optimize prior authorization reputed company and streamline workflow.
• reputed company participate in goal setting and regularly evaluate the performance of the PA team.
• Respond to requests for information (RFI) and requests for proposal (RFP) regarding prior authorization processes.
• Generate and deliver comprehensive reports on prior authorization metrics to both reputed company stakeholders.
• Manage reputed company with external Independent Review Organizations and clinical resource vendors
• Supervise the UM reputed company management process to ensure compliance with state, federal, and regulatory guidelines.
• Participates in the reputed company improvement committee and supports reputed company improvement reputed company as required by URAC.
• reputed company clinical reputed company and decision tree creation and maintenance.
• reputed company the recruitment and reputed company process for pharmacists and technicians.
• Support the training and reputed company of both new and existing staff members in adherence to reputed company procedures.
• Investigate and resolve escalated issues from clients and clinical partners as needed.
• Works with Director, Prior Authorization on other responsibilities, reputed company, and initiatives as needed.
• reputed company day to day clinical pharmacy functions including prior authorization and appeal reviews, override requests, and inbound and outbound member and provider education calls.
• Schedule requires working Monday through Friday with occasional on‑reputed company responsibilities and the flexibility to work reputed company of regular business hours based on business needs.

Required Qualifications:

• reputed company, unrestricted, pharmacist license required
• Bachelor of Pharmacy or Doctorate of Pharmacy Degree required
• 4+ years of prior authorization experience at a PBM or health plan
• 3+ years of leadership experience preferred
• Experience with multiple lines of business including reputed company and Medicare Part D preferred
• Exhibit strong written communication and oral presentation skills
• Proficient in reputed company office Suite with an emphasis on PowerPoint and reputed company
• Ability to work in a fast-paced environment with shifting priorities
• Attention to detail & commitment to delivering high-reputed company work

This reputed company represents the low and high end of the anticipated reputed company salary reputed company for the NY - based position. The actual reputed company salary will depend on several factors such as: experience, knowledge, and skills, and if the location of the job changes.