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Point32Health Supervisor, Pharmacy Utilization Management in Canton, Massachusetts

We enjoy the important work we do every day on behalf of our members.

Please note: As of January 18, 2022, all employees — including remote employees — must be fully vaccinated. This position will require the successful candidate to show proof of full vaccination against COVID-19. Point32Health is an equal opportunity employer, and will consider reasonable accommodation to those individuals who are unable to be vaccinated consistent with federal, state, and local law.

Job Summary

Under the direction of Director, Pharmacy Utilization Management (UM), the Pharmacy UM Supervisor is responsible for the day-to-day operations of the UM unit and is charge of planning, coordinating, implementing and evaluating to ensure process is running efficiently. The Supervisor is an active participant in the drug prior authorization (PA) request process and is responsible for communication and training of staff. The Supervisor works in conjunction with Director of Pharmacy UM to establish department goals and objectives and ensure all compliance requirements are met.

Job Description

  • Supervises UM team (pharmacy technicians and clinical pharmacists), including but not limited to the following responsibilities: interviewing, onboarding and training employees; providing on-going coaching, mentoring, and development of employees, fostering an atmosphere of teamwork; establishing performance goals with employees and monitoring progress with regard to achievement of those goals; planning, scheduling and directing the work of employees; evaluating employees’ performance and productivity; taking disciplinary actions with employees as needed; addressing employee complaints and grievances; making effective recommendations with regard to the hiring, firing, promotion and other status changes of employees.

  • Active participant in processing drug prior authorization (PA) requests and ensure all queues in automated prior authorization tools are in good standing.May have to occasionally staff early mornings, evenings and be On-Call during the weekend when needed.

  • Performs daily quality checks of pharmacists and technicians to ensure CMS and Point32Health guidelines are met.

  • Participates in implementing and maintaining policies and procedures, workflows and training to support the processing of pharmacy PA requests, consistent with applicable regulatory and accreditation requirements and turnaround times.

  • Works in conjunction with the Director of Pharmacy UM to establish department goals and objectives as they relate to Point32Health and compliance requirements.

  • Supervises all departmental reporting requirements in conjunction with the Director of Pharmacy UM

  • Provides ongoing education and communications to staff to maximize individual and UM growth.

  • Participates in interdepartmental meetings as necessary, including but not limited to Drug Coverage Committee, and Clinical Pharmacy Team

  • Continually monitors processes to maximize use of staff and supplies with a redirect if needed. Monitors timeliness based on systems dashboard or production monitoring reporting.

  • Performs other duties and projects as assigned by Director of Pharmacy UM

Requirements

EDUCATION: (Minimum education & certifications required)

  • A minimum of a BS degree in Pharmacy or PharmD

  • Current registration and good standing with the Board of Pharmacy.

EXPERIENCE: (Years of experience)

  • Minimum of 5 years full-time experience as a pharmacist, preferably PBM and/or managed care setting and 2 or more years of managerial experience.

  • Expert knowledge of the principles and practices of pharmaceutical science. Working knowledge of federal and state controlled substance and pharmacy laws, rules and regulations.

  • Knowledge of drug coding (NDC, GCN, GPI and USC) and NCPDP claims adjudication systems.

  • Previous working knowledge of MedHOK, RxClaims, CAS and CCMS system a plus.

  • Knowledge of or experience with Medicare Part B & D, Medicaid, Commercial and Drug Utilization Management

  • Prior authorization experience, including reviewing drug use criteria for medication approval.

SKILL REQUIREMENTS:

  • Requires analytical ability to independently research/ summarize data on drug utilization and spend.

  • Excellent written and verbal communication skills.

  • Strong PC skills with MS Office (Word, Excel, PowerPoint & Access) and ability to learn/use new database and reporting applications.

  • High degree of professionalism and confidence.

  • Ability to recognize politically sensitive issues and utilize diplomacy.

  • Ability to interact effectively with all levels of management.

  • Must be self-motivated and capable of working independently with minimal supervision.

  • Must be capable of organizing, facilitating and managing several projects simultaneously.

  • Must be flexible and able to constantly review and reset priorities; often daily.

  • Critical thinking skills and ability to oversee teams to meet expected goals.

  • Ability to manage conflicts; manage risks and resources while assuring quality and appropriate communications.

  • Build and motivate teams and provide necessary leadership to achieve project objectives.

What we build together changes our customer's health for the better. We are looking for talented and innovative people to join our team. Come join us!

Please note: As of January 18, 2022, all employees — including remote employees — must be fully vaccinated. This position will require the successful candidate to show proof of full vaccination against COVID-19. Point32Health is an equal opportunity employer, and will consider reasonable accommodation to those individuals who are unable to be vaccinated consistent with federal, state, and local law.

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