Supervisor, Pharmacy - Denver Health Medical Plan (Must Live in Colorado. Weekly On-Site Requirement)

Benefits

Additional Information

We are recruiting for a mission-driven Supervisor, Pharmacy - Denver Health Medical Plan (Must Live in Colorado. Weekly On-Site Requirement) to join our team! We're with you for life's journey. At Denver Health, purpose isn't just something we believe in-it's something we live every day, for life's journey. Our Values Respect | Belonging | Accountability | Transparency Department Managed Care Administration * Must Live in Colorado * This is a hybrid role located in Denver, Colorado with a requirement of being in the office 3 days per week. Job Summary The Supervisor, Managed Care Pharmacy, performs supervisor/leadership functions over the Denver Health Medical Plan (DHMP) / Managed Care Pharmacy clinical pharmacist and administrative staff. Applies critical thinking, clinical knowledge, evidence-based policies, procedures, guidelines, and competence to collaborate with the team to promote excellence and quality outcomes. Adheres to all Federal, State, and local laws, regulations, applicable health plan pharmacy services, and plan design. The primary role of the Supervisor is to provide operational and collaborative leadership for the Managed Care Pharmacy Department, with specific attention to quality of care, timely access, supervision, and mentorship for the pharmacy clinical staff and call team. An essential goal of this role is to maximize efficiency and positively impact the care provided to our members. The incumbent will be adept at collaborating with different teams within the organization. In collaboration with the Director, leads the development of specific departmental goals, standards, and objectives that directly support the strategic plan and vision of the organization. Promotes department sustainability and cost containment efforts to achieve budget. Identifies and implements strategies to monitor variance reports to enhance productivity while maintaining high-quality service. Implements programs that promote high motivation among team members by coaching, counseling, and setting goals for direct reports. Essential Functions : Supervises Pharmacist Clinical Specialist and Pharmacy Technician Call Center staff. Sets and communicates expectations to each employee and establishes job requirements and performance appraisal components. Regularly provides individual assessments to the Pharmacist Clinical Specialist and Pharmacy Technician Call Center staff to ensure timely feedback on performance expectations. (20%) Performs timeliness monitoring, prior authorization, and call center auditing. Results are shared with staff, and corrective action plans will be implemented if deemed necessary. Presents annual reports of this data to the Medical Management Committee (MMC) and Quality Management Committee (QMC). Maintains assigned measures and documentation associated with National Committee for Quality Assurance (NCQA) accreditation. (10%) Work with the clinical and operations staff of all vendors of pharmacy programs, including support to internal operational departments on implementing various programs. (10%) Completes Prior Authorization requests clinical reviews and keeps current knowledge of system issues, processes, etc. Provides this feedback to the PBM and works with them to resolve issues. (10%) Responsible for maintaining and updating Departmental Operating Procedures (DOPs) and Policy and Procedures (P&Ps) related to call center and prior authorization processes and oversight. (10%) Handles Call Center escalations and works to resolve issues related to grievance and appeals, enrollment, etc. Maintains processes and communication between Managed Care Call Center teams and other relevant departments for efficiencies (10%) Establishes and updates inbound and outbound call scripts. Creates standard workflows, identifies process gaps, and challenges self and others to develop and implement solutions. (10%) Evaluate and identify opportunities for improved management of drug benefits through clinical research and analytics that improve medical/pharmacy cost savings and provide clinical quality initiatives. (10%) Develop, implement, and manage pharmacy cost containment strategies, including high-risk, high-cost, and high-use medications, to determine the most appropriate medication use management strategy for identified medications. (10%) Education : Bachelor's degree B.Pharm required Work Experience : 1-3 years managerial/supervisory experience required or 1-3 years pharmacy, managed care, and/or pharmaceutical industry experience required Licenses : PHA-Licensed Pharmacist - DORA - Department of Regulatory Agencies required Knowledge, Skills and Abilities : Excellent verbal and written communication skills with the ability to communicate and collaborate effectively with all internal stakeholders. Strong interpersonal, consultation, organizational, tracking, and follow-up skills. Data review and interpretation skills are preferred to identify and resolve drug-related problems and trends

Your Match

How well this role fits your profile.

Company Intel

What employees say

Worked at denverhealth? Share your experience