Description:

JOB SUMMARY

We are seeking a dedicated and detail-oriented Clinical Pharmacy Manager for an operation-centric role focused on oversight of the pharmacy department and review of medical data to facilitate prior authorization for specialty medications. Provides oversight of clinical pharmacy services and support to assist the Prior Authorization, Case Management and Quality teams.

ESSENTIAL DUTIES AND RESPONSIBILITIES

Include the following. Others may be assigned.

• Oversight Prior Authorization review and approve or deny coverage for pharmaceuticals based on medical necessity criteria. Coordinates with medical directors as needed
• Oversee the clinical pharmacy staff to include pharmacy technician(s) and other clinical pharmacist(s).
• Plans and implements drug utilization management and quality improvement plans.
• Assists with Transitions of Care Medication Reconciliation Post-Discharge (TOC MRP)
• Supports Quality with Medication Adherence Measures
• Acts as liaison with contracted Pharmacy Benefit Management (PBM) companies for the purposes of drug utilization management, quality assurance programs, and physician education.

SUPERVISORY RESPONSIBILITIES

If direct report positions are listed below, the following responsibilities will be performed in accordance with guidelines, policies and procedures and applicable laws. Supervisory responsibilities include interviewing, hiring, and training employees; planning, assigning and directing work; appraising performance; rewarding and disciplining employees; addressing complaints and resolving problems.

• Direct Reports (titles) Clinical Pharmacist, Pharmacy Technicians
• Indirect Reports (titles) N/A

KNOWLEDGE, SKILLS, ABILITIES

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions

• Three (3) to Five (5) years of clinical pharmacy experience.
• One (1) to Three (3) years of pharmacy business operations as a people manager
• Two years of managed care experience in Medical Management.
• ICD-9 and CPT coding experience preferred.
• Experience in EZ-CAP preferred.
• Ability to communicate effectively both verbally and in writing.
• Experienced computer skills with Microsoft Word, Microsoft Outlook, Excel and experience working in a health plan medical management documentation system.

Conifer requires its candidates, as applicable and as permitted by law, to obtain and provide confirmation of all required vaccinations and screenings prior to the start of employment. This may include, but is not limited to, the COVID-19 vaccination, influenza vaccination, and/or any future required vaccines and screenings.

EDUCATION / EXPERIENCE

Include minimum education, technical training, and/or experience preferred to perform the job.

• Requires a PharmD
• Previous Management / Leadership experience
• Experience reviewing Medical Drugs (J-codes and Q-codes)
• Prior Authorization experience

REQUIRED CERTIFICATIONS/LICENSURE

Include minimum certification required to perform the job.

• Current Pharmacist license
• Must possess an active unrestricted state license to practice pharmacy as a Registered Pharmacist (RPh)
• Strong oral, written and interpersonal communication skills, problem-solving skills, facilitation skills, and analytical skills a must

PHYSICAL DEMANDS

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

• Must be able to work in sitting position, use computer and answer telephone
• Ability to travel
• Includes ability to walk through hospital-based departments across broad campus settings, including Emergency Department environments

WORK ENVIRONMENT

The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

• Office Work Environment

OTHER

• Some travel may be required

As a part of the Tenet and Catholic Health Initiatives family, Conifer Health brings 30 years of healthcare industry expertise to clients in more than 135 local regions nationwide. We help our clients strengthen their financial and clinical performance, serve their communities and succeed at the business of healthcare. Conifer Health helps organizations transition from volume to value-based care, enhance the consumer and patient healthcare experience and improve quality, cost and access to healthcare. Are you ready to be part of our solutions? Welcome to the company that gives you the resources and incentives to redefine healthcare services, with a competitive benefits package and leadership to take your career to the next step!

Compensation and Benefit Information

Compensation

• Pay: $104,624.00 - $156,957.00 annually. Compensation depends on location, qualifications, and experience.
• Position may be eligible for an Annual Incentive Plan bonus of 10%-25% depending on role level.
• Management level positions may be eligible for sign-on and relocation bonuses.

Benefits

Conifer offers the following benefits, subject to employment status:

• Medical, dental, vision, disability, life, and business travel insurance
• Management time off (vacation & sick leave) – min of 12 days per year, accrued accrue at a rate of approximately 1.84 hours per 40 hours worked.
• 401k with up to 6% employer match
• 10 paid holidays per year
• Health savings accounts, healthcare & dependent flexible spending accounts
• Employee Assistance program, Employee discount program
• Voluntary benefits include pet insurance, legal insurance, accident and critical illness insurance, long term care, elder & childcare, AD&D, auto & home insurance.
• For Colorado employees, Conifer offers paid leave in accordance with Colorado’s Healthy Families and Workplaces Act.

2503006876 Minimum Qualifications Full Time

Employment practices will not be influenced or affected by an applicant's or employee's race, color, religion, sex (including pregnancy), national origin, age, disability, genetic information, sexual orientation, gender identity or expression, veteran status or any other legally protected status.

Tenet participates in the E-Verify and Work Opportunity Tax Credit (WOTC) programs. Follow the links below for additional information.

E-Verify: http://www.uscis.gov/e-verify
WOTC: https://www.doleta.gov/business/incentives/opptax