Supervisor Pharmacy Services - Prior Authorization at Cambia Health Solutions

Posted in Other 7 days ago.

Location: Medford, Oregon





Job Description:

Supervisor Pharmacy Services - Prior Authorization

Remote Option Available (Except CO)


The Supervisor Pharmacy Services Prior Authorization under guidance of Manager, Prior Authorization Operations, develops and initiates the direction, goals and objectives for department service levels to ensure the processing of prior authorization requests in compliance with policies and procedures. Ensures adherence to company and National Accreditation requirements. Coordinates and administers workflow. Monitors and audits production and performance of Pharmacy Prior Authorization staff, and generates routine reports.



Responsibilities


  • Ensures proper training for all new and existing employees, including temporary employees and pharmacy intern students, as needed. Training sessions take place at Cambia offices in Oregon, Washington, Idaho and Utah.

  • Responsible for being knowledgeable about all contracts, drug programs and benefits, and to demonstrate the ability to administer policies consistently in accordance with contracts.

  • Provides ongoing performance feedback and professional development to each employee on a routine basis. This time is used to assist, motivate, and train employees to enable them to meet or exceed requirements and standards.

  • Responsible for maintenance of the department policies and procedures manual.

  • Updates Pharmacy PA communication tools, including PA database and letters.

  • Manages and directs workflow. Evaluates productivity and quality of work, and reports individual and department performance on a weekly and monthly basis.

  • Reviews volume and nature of workload handled by department staff. Presents recommendations to management to correct potential problems and identifies training/education opportunities. Communicates with other departments to resolve issues and provide training as needed.

  • Monitors status of department projects to ensure they are being managed according to department policies and procedures.

  • Conducts interviews and makes hiring decisions.

  • Conducts formal performance reviews.

  • Resolves intra-departmental conflicts and takes disciplinary action when necessary.

  • Communicates with employees in Marketing, Group Accounting, Claims and Customer Service to ensure the highest degree of subscriber service possible.

  • Performs detailed analyses of work processes and output in an effort to continuously improve both.

  • Coordinates special projects as requested by management.

  • Attends meetings as needed.

  • Facilitates department staff meetings on a regular basis. Provides information regarding new products and groups. Provides updates on corporate and/or department policy and procedure changes.

  • Tracks and approves the department bi-weekly time reporting system.


Requirements

  • Demonstrated knowledge of the health care industry with emphasis on the pharmacy benefits management industry; medical terminology, pharmaceutical products, including orals, injectables, infusion products, and chemotherapy; health care coding systems such as ICD-9, CPT, and HCPCS. Experience with URAC, NCQA, and Medicare Part D regulations desirable.

  • Demonstrated proficiency in Microsoft Word and Excel and general office practices and procedures.

  • Demonstrated ability to create a unified, productive work environment for department staff.

  • Ability to prioritize individual and department workload including ability train new and existing employees on job requirements.

  • Demonstrated oral and written communication skills including ability to translate and present pharmacy & Rx benefit information in both formal and informal settings.

  • Manage production of training materials and documentation of department policies.

  • Maintain consistent professional, service oriented relations with all levels of employees.

  • Demonstrated versatility while performing tasks in a fast-paced, pressured environment.

  • Instruct, motivate, and direct individuals face-to-face, over the phone, or in written communications.

  • Demonstrated ability to use good judgment and problem solving skills including ability to exercise judgment in confidential and sensitive issues.

  • Demonstrated ability to adapt to change and coach employees on change management as necessary.

  • Ability to grasp new policies and procedures quickly.

  • Demonstrated ability to maintain attendance at or above the company standard.



Normally to be proficient in the competencies listed above




The Supervisor Pharmacy Services Prior Authorization would have a Bachelor's degree in general education or related field with a minimum of six years of experience as a pharmacy technician in retail, hospital or other licensed pharmacy setting and three years of leadership experience either as a Pharmacy Tech Lead or other leadership role or an equivalent combination of education and experience.


Regence employees are part of the larger Cambia family of companies, which seeks to drive innovative health solutions. We offer a competitive salary and a generous benefits package. Regence is 2.2 million members, here for our families, co-workers and neighbors, helping each other be and stay healthy and provide support in time of need. We've been here for members for 100 years. Regence is a nonprofit health care company offering individual and group medical, dental, vision and life insurance, Medicare and other government programs as well as pharmacy benefit management. We are the largest health insurer in the Northwest/Intermountain Region, serving members as Regence BlueShield of Idaho, Regence BlueCross BlueShield of Oregon, Regence BlueCross BlueShield of Utah and Regence BlueShield (in Washington). Each plan is an independent licensee of the Blue Cross and Blue Shield Association.


If you're seeking a career that affects change in the health care system, consider joining our team at Cambia Health Solutions. We advocate for transforming the health care system by making health care more affordable and accessible, increasing consumers' engagement in their health care decisions, and offering a diverse range of products and services that promote the health and well-being of our members. Cambia's portfolio of companies spans health care information technology and software development; retail health care; health insurance plans that carry the Blue Cross and Blue Shield brands; pharmacy benefit management; life, disability, dental, vision and other lines of protection; alternative solutions to health care access and free-standing health and wellness solutions.


This position includes 401(k), healthcare, paid time off, paid holidays, and more. For more information, please visit www.cambiahealth.com/careers/total-rewards.


We are an Equal Opportunity and Affirmative Action employer dedicated to workforce diversity and a drug and tobacco-free workplace. All qualified applicants will receive consideration for employment without regard to race, color, national origin, religion, age, sex, sexual orientation, gender identity, disability, protected veteran status or any other status protected by law. A drug screen and background check are required.


If you need accommodation for any part of the application process because of a medical condition or disability, please email CambiaCareers@cambiahealth.com. Information about how Cambia Health Solutions collects, uses, and discloses information is available in our Privacy Policy.

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