Pharmacist Manager, Medicare Utilization Management

• Position ID #: PBM040825UM
• Location: Various Cities
• Required Education: PharmD
• Salary Range: $145,000 - $160,000
• Required Experience: Three- Five Years
• Commission Range: N/A
• Other: Bonus, Benefits
• Required Travel: N/A
• Relocation: N/A
• 
  Description:
  Rapidly Growing Player in the Pharmacy Benefits Management (PBM) marketplace seeks a Manager, Medicare Utilization Management-Pharmacist who will act as subject matter expert on prior authorization and appeals operations that are compliant with CMS guidelines.
  
   Some of the expected job functions include:
  • Serve as the Medicare coverage determinations and redeterminations subject matter expert
  • Recruiting, onboarding, training, and managing of Medicare PA and Appeals pharmacists and technicians
  • Manage contracts with government, state, and other regulatory vendors
  • Oversee the draft of Medicare denial verbiage templates
  • Actively participate in goal setting and regularly evaluate the performance of the team
  • Generate and deliver comprehensive reports on prior authorization to both internal and external stakeholders
  • Works with Director, Prior Authorization on other responsibilities, projects, and initiatives as needed
  • Responsible for adherence to the Company Code of Conduct including reporting of noncompliance
  
  The compensation plan includes a competitive salary ($145,000 - $160,000 d/o/e), plus bonus and benefits.
  
  This position can be filled “remotely”, or as “hybrid”, should the candidate live in the NYC-Metro area.
• 
  Requirements:
  The ideal candidate for this position has at least two (2) years of prior authorization review and/or appeals experience in the Medicare space.
  • 2+ years of Medicare PA leadership experience required
  • Experience with managing large remote teams preferred
  • Medicare implementation experience preferred
  • 4+ years of experience at a PBM or health plan preferred
  • Active, unrestricted, pharmacist license required
  • Exhibit strong written communication and oral presentation skills
  • Proficient in Microsoft office Suite with an emphasis on PowerPoint and Excel
  
  Qualified candidates should send their resumes in MS Word format to: mail@phoenixhealthsearch.com