Manager, Medicare Utilization Management Pharmacist - Remote

Overview

This role involves managing and optimizing Medicare prior authorization and appeals processes while ensuring compliance with CMS guidelines. You will oversee a team of pharmacists and technicians, enhancing operational efficiency and streamlining workflows.

In Short

• Manage Medicare prior authorization and appeals processes
• Oversee a team of pharmacists and technicians
• Create and maintain policies and procedures
• Forecast staffing needs and streamline workflows
• Manage contracts with regulatory vendors
• Collaborate with internal stakeholders
• Drive team performance and provide training
• Generate reports on prior authorization
• Investigate and resolve escalated issues
• Perform clinical pharmacy functions

Requirements

• 2+ years of Medicare PA leadership experience
• Experience managing large remote teams preferred
• Medicare implementation experience preferred
• 4+ years of experience at a PBM or health plan preferred
• Active pharmacist license required
• Strong written and oral communication skills
• Proficient in Microsoft Office Suite
• Self-starter in a fast-paced environment

Benefits

• Competitive salary
• Remote work options
• Comprehensive health benefits
• Professional development opportunities
• Diverse and inclusive workplace