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WellCare - Pharmacy Management Careers

Pharmacy Operations - Senior Manager Job

Full Job Title: Sr Manager, Pharmacy Operations

Job Number: 1705725

Location: Tampa, FL

Date Posted: 12-13-2017

Department: Pharmacy

Reports to: Director Pharmacy Operations

Location: 4110 George Road, Tampa FL 33464

Oversees daily processing of all coverage determination requests/prior authorization requests for all Company lines of business. Continuously monitors daily operations such as claims volumes and staffing needs for the department via pharmacy operations workflow tools and improves work flows for achieving compliance requirements and establishes processes to monitor adherence of cases (compliance and quality). Reviews and executes changes in workflow as the Company business changes (including development of new protocols for medications). Ensures compliance with all state guidance, federal guidance and Company policies to include compliance monitoring of requests, quality monitoring of requests and clinical review of requests. Serves as a mentors to clinical leaders within the pharmacy department.

Note: The following is not intended to be an exhaustive list of all duties required of this position
Key Duties and Responsibilities
Manages processes and projects that are aligned directly to pharmacy operational goals and budgets.
Establishes objectives, schedules, and cost data of business function being managed.
Facilitates the development and implementation of the departments SMART goals and performance standards.
Works closely with the department senior leadership to implement high level quality and performance management initiatives, including timely coaching, team member development and proactive engagement strategies.
Plans, reviews, conducts and directs work on daily work as well as complex projects/programs for short and long term performance optimization.
Ensures corporate initiatives are implemented to achieve optimum results.
Directs, develops and implements appropriate changes in department policy and procedures under the guidance of the Directors of Operations.
Reviews Medicare and Medicaid coverage determination requests/prior authorization requests for clinical appropriateness, medical necessity, and accurate dosing, provider, and place of service.
Provides leadership and technical direction to functional supervisors, managers and other management.
Ensures team associates meet departmental goals of compliance, productivity, and quality.
Ensures associates handle prior authorization/coverage determination requests within all federal and state regulatory compliance time frames.
Key stakeholder and active participant in Pharmacy Operations Quality Management Council activities including ensuring cooperation and adherence to department operational procedures, clinical criteria justifications, error trending and tracking and compliance (accountability policy) execution.
Presents medication reviews at Pharmacy and Therapeutics Committee meetings.
Reviews pharmacy claims data to identify possible clinical savings opportunities.
Develops and ensures departmental policies and procedures are created and comply with all state contracts and federal regulations with focus on compliance and quality.
Proactively develops and delivers communications and/or presentations to for key department senior leaders.
Develops and assists with the implementation of medication decision tools.
Performs other duties as assigned.
State the minimum required for the job
Education Level
Education Details
A Bachelor's Degree in
A Doctor of Pharmacy (PharmD)

Work Experience
State the minimum required for the job
Experience Level
Experience Details
5 years of experience in
licensed pharmacy with exposure to managed care
2 years experience in leading/supervising others
Experience with state and federal managed care compliance regulations

Licenses and Certifications
List professional licenses and certifications associated with this job
Other Licenses/Certifications
Licensed pharmacist in state of operation

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Last Updated On: 12/9/2015