Posted in Other 30+ days ago.
Type: Full Time
MANAGER, PHARMACY CLINICAL OPERATIONS
Requisition #: 275104
Location: Johns Hopkins Health Care, Hanover, MD 21076
Category: Pharmacy
Work Shift: Day Shift
Work Week: Full Time (40 hours)
Weekend Work Required: No
Date Posted: Nov. 23, 2020
Johns Hopkins HealthCare (JHHC) is the managed care and health services business of Johns Hopkins Medicine, one of the premier health delivery, academic, and research institutions in the United States. JHHC is a $2.5B business serving over 400,000 lives with lines of business in Medicaid, Medicare, commercial, military health, health solutions, and venture investments. JHHC has become a leader in provider-sponsored health plans and is poised for future growth.
Many organizations talk about transforming the future of healthcare, Johns Hopkins HealthCare is actually doing it. We develop innovative, analytics-driven health programs in collaboration with provider partners to drive improved quality and better health outcomes for the members and communities we serve. If you are interested in improving how healthcare is delivered, join the JHHC team.
Position Summary:
The Manager, Pharmacy Clinical Operations is responsible for planning, managing and organizing the functions of the pharmacy prior-authorization unit to ensure compliance with all clinical standards, contract requirements and successful and timely completion of all business processes. Other responsibilities include management and evaluation of all clinical and non-clinical departmental functions, coordination with the Pharmacy Benefit Manager (PBM) to ensure accurate and timely programing of formulary and drug benefit changes, resolution of escalated internal and external service requests, coordinating the receipt and delivery of regulatory reports, supporting the day to day business relationship, directs and manages the implementation of pharmacy communication strategy and coordinates required reporting delivered to State and Federal regulatory agencies. This position will be the primary point of contact for all PBM, vendor, benefit systems, claims, and operational inquiries.
Task requirements for position:
*Accountable for the review of prior authorizations and non-formulary requests to ensure the efficient delivery, clinical appropriateness, and optimization of care; including assisting in the management of work process flows.
*Works closely with department leadership and Medical Directors to ensure compliance within all areas of prior-authorizations and non-formulary requests.
*Manages and develops direct reports who include other supervisory personnel and ensures the delivery of superior pharmacy operations service and member satisfaction.
*Develops, manages, and monitors performance for production, quality, and compliance. (i.e.: clinical criteria justifications, prior authorization / non-formulary review decisions and application of department workflow processes)
*Hires, trains, coaches, counsels, and evaluates performance of direct reports.
*Reports and analyzes clinical audit productivity and trends and develop and executes corrective actions as needed.
*Partners with department leadership to review, develop and ensure execution on departmental policies and procedures in conjunction with all state, federal, and contractual requirements and that authorization/non-formulary requests are handled within all federal and state regulatory compliance time frames.
*Lead and present at assigned committees/tasks.
*Performs special projects as assigned.
*Assist Pharmacy Director with oversight of clinical and operational programs provided by PBM and other pharmacy vendors,
*Assist Pharmacy Director with monitoring business processes and project plans as needed
Requirements:
A. Education:
Bachelor s degree in Pharmacy, Doctor of Pharmacy (PharmD) preferred.
B. Knowledge:
Prefer a comprehensive understanding of managed care, concepts and principles, and the application of specific JHHC benefit plans.
Comprehensive and expert understanding of a pharmacy prior-authorization unit providing prior-authorization request reviews, customer service and associated functions, such as call center metrics and reporting requirements, and pharmacy utilization metrics
C. Skills:
Requires excellent communication, both oral and written, as well as strong interpersonal skills to effectively interface with all internal and external customers.
Requires good analytical ability in order to complete tasks assigned, gather and interpret data from different sources and to resolve complex problems.
Work requires reinforcing quality and customer service standards; analyzing and resolving quality and customer service issues; identifying trends, and recommending procedural and process improvements
Requires excellent leadership skills, including the ability to prioritize, problem-solve and multi-task in a fast-paced environment.
Requires the ability to handle sensitive and confidential information; communicate and exchange information with all internal and external customers.
Work requires a comprehensive and expert knowledge of workforce management activities and reporting.
D. Required Licensure, Certification, Etc.:
Maryland Pharmacy license.
E. Work Experience:
Requires a minimum of 5 years of experience in pharmacy. Prior Managed Care or Pharmacy Benefit Manager (PBM) experience preferred.
F. Machines, Tools, Equipment:
Must be able to operate general office and communications equipment.
Dimensions:
A. Budget Responsibility:
Effectively uses resources within control.
B. Authority/Decision Making Level:
Makes decisions regarding work processes based on established guidelines.
Prioritizes and organizes work to meet changing priorities.
Works collaboratively with limited supervision.
C. Supervisory Responsibility:
Manages staff and daily activities of an inbound call center. Has responsibility for the hiring, and accomplishing staff results by communicating job expectations, planning work, monitoring performance and appraising job results; coaching, and performance managing employees; initiating, coordinating, and enforcing systems, policies and procedures. Provides developmental and growth opportunities for staff.
Problem Solving:
Uses operational metrics and other indicators to analyze staffing needs and department workflows and procedures in order to improve customer service.
Information Management:
Responsible for the proper flow and completion of information from the vendors, as well as using critical thinking skills and defined procedures to resolve problems or issues that arise.
Must be able to compile and communicate Individual staff performance statistics as required in the performance standards and make recommendations for service enhancements or improvement.
Working Conditions:
Works in normal environment where there are no physical discomforts due to dust, dirt, noise and the like.
Work is sedentary in nature; however, some standing, stooping, and bending is required. The position requires activity, pulling and filing.
Work requires concentration and constant attention to accuracy and detail for extended periods of time.
Johns Hopkins Health System and its affiliates are Equal Opportunity/Affirmative Action employers. All qualified applicants will receive consideration for employment without regard to race, color, religion, sexual orientation, gender identity, sex, age, national origin, disability, protected veteran status, and or any other status protected by federal, state, or local law.
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