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Manager, Prior Authorizations

RxBenefits, Inc., 3700 Colonnade Parkway, Birmingham, Alabama, United States of America Req #143
Friday, October 25, 2019
Founded in 1995, RxBenefits occupies a unique niche in the healthcare benefits industry as a strategic expert on pharmacy benefit procurement and administration.  Staffed by veterans of the benefit and pharmacy industries, our first specializes in advocacy services for consultants on behalf of employers, employees, and their covered dependents.  With our guidance and specialized expertise, clients maximize the value of their pharmacy benefits, enjoying a significant increase in services and cost savings.  As a proven pharmacy partner, RxBenefits provides all pharmacy benefit manager (PBM) administrative services, ensures contract criteria and performance guarantees are met or exceed requirements, and produces quantitative results on the value of the offerings. Our firm is the only pharmacy administration company in the U.S. that brings award-winning service to employers while leveraging the industry-leading capabilities of top PBMs. RxBenefits serves a national client base from our headquarters in Birmingham, Alabama.

Manager, Prior Authorizations

RxBenefits is hiring! The Manager, Prior Authorizations will be responsible for managing the day to day operations and team of our newly created Prior Authorizations Department. This role will be located in Birmingham, AL at our corporate office.

Job Responsibilities Include:
• Manage a team of pharmacists and pharmacy technicians ensuring each team member follows set policies and procedures, process and workflow requirements, and criteria requirements
• Work closely with our PBM partners to ensure the most up-to-date criteria versions are on-hand. This includes new drugs and existing drugs to which new FDA approved indications are added.
• Use updated and/or new PBM supplied criteria to ensure the software platform is up to date by ensuring new product development, explanations, decision scenarios, and testing have been completed prior to production in our live PA environment (to which outcomes and the member experience are ultimately affected)
• Develop new policies and procedures as necessary around the PA process creating/generating efficiencies within the team and organization-wide creating a more broker/client friendly experience that ultimately provides the best member experience possible
• Monitor workflow to ensure no bottlenecks are occurring and work to “even out” the workflow to create efficiencies making sure to get the PAs turned around as quickly as possible to provide an excellent member experience
• Maintain a good working relationship with our print vendor to ensure members receive their communications/notifications in a timely manner
• Lead bi-weekly calls with our software vendor to ensure smooth operation of the PA software, resolution of any identified issues, and progress on requested enhancements
• Use the software vendor’s portal to submit custom or change requests that will enhance workflow and productivity as well align with the company’s vision around the PA process, with manager approval
• Ensure quarterly software releases are successful by testing them in advance (within the testing environment) to stay up to date with (future) global releases as well selection of (future) “flagged” releases that apply to our instance of the software. Once quarterly releases are successfully made available (per the release schedule), ensure proper configuration within the software platform in order to maintain system functionality
• Ensure training guides and materials are up to date with the latest software update/releases to ensure PA team (directed mainly towards new members of the team) has the “tools” they need to successfully work through the PA process – with specific attention to the newest features/enhancements incorporated in the software updates/releases
• Develop reporting metrics and work internally with IT to develop our internal analytics tool to better serve our Account Management team
• Evaluate various KPI’s (Key Performance Indicators) including pharmacist and pharmacy technician performance [number of PAs worked], approvals, denials, early closes, withdrawals, dismissals, turnaround times, standard versus urgent requests and appeals, etc. and implement operational changes to continually improve departmental results
• Work closely with other team members throughout the organization (member services, client services, and account management) to ensure excellent member service is provided and that other teams throughout the organization are aware of new enhancements being implemented by the PA review team

Required Skills / Experience Include:
• Four-year college degree from an accredited institution
• Current pharmacy license required – PharmD or RPH
• 5+ years of clinical advising in a retail, hospital, or specialty pharmacy
• 3+ years of management experience (processes and people)
• Previous Prior Authorizations experience, preferred

RxBenefits is an equal opportunity employer where an applicant's qualifications are considered without regard to race, color, religion, sex, national origin, age, disability, veteran status, genetic information, sexual orientation, gender identity or expression, or any other basis prohibited by law.

Other details

  • Job Family Health Services
  • Pay Type Salary
  • Employment Indicator Regular
  • RxBenefits, Inc., 3700 Colonnade Parkway, Birmingham, Alabama, United States of America