Manager Pharmacy Prior Authorizations at Elevance Health in St. Louis, Missouri

Job Description:

Description


Be Part of an Extraordinary Team

BioPlus Specialty Pharmacy is now part of CarelonRx (formerly IngenioRx), and a proud member of the Elevance Health family of companies. Together, CarelonRx and BioPlus offer consumers and providers an unparalleled level of service that's easy and focused on whole health. Through our distinct clinical expertise, digital capabilities, and broad access to specialty medications across a wide range of conditions, we deliver an elevated experience, affordability, and personalized support throughout the consumer's treatment journey.

LOCATION: Candidates must reside within 50 miles or 1-hour commute each way of 1831 Chestnut St, St Louis, MO 63103

SHIFT : Monday-Friday (occasional weekends if needed). Rotating schedule between 8-5 & 10-7

Build the Possibilities. Make an Extraordinary Impact.


The Manager Pharmacy Prior Authorizations is responsible for managing a team of pharmacy associates who facilitate patient access to pharmaceutical therapy through the prior authorization process.

How you will make an impact:

Primary duties may include, but are not limited to:

• Ensures adherence to formulary and member benefit structures to provide service that is medically appropriate, high quality, and cost effective.
  
• Manages associates who assist providers gain authorizations for medications and determining appropriate routes of billing by utilizing the applicable medical policy and industry standards.
  
• Ensures the accurate interpretation of benefits and managed care guidelines along with guiding patients to appropriate programs or resources.
  
• Applies clinical knowledge to work with facilities and providers for care-coordination.
  
• Occasionally manages appeals for denied pharmacy services.
  
• Serves as the subject matter expert for other areas of the company and within the department.
  
• Develops and manages annual operating budget.
  
• Hires, trains, coaches, counsels, and evaluates performance of direct reports.
  

Minimum Requirements:

• Requires BA/BS degree and a minimum of 2 years previous management experience and a minimum of 5 years customer service experience related to the provision of financial assistance or pharmacy billing; or any combination of education and experience which would provide an equivalent background.
  

Preferred Skills, Capabilities and Experiences:

• Previous pharmacy leadership experience preferred.
  
• Pharmacy prior authorization experience strongly preferred.
  

Please be advised that Elevance Health only accepts resumes for compensation from agencies that have a signed agreement with Elevance Health. Any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of Elevance Health.

Who We Are

Elevance Health is a health company dedicated to improving lives and communities - and making healthcare simpler. We are a Fortune 25 company with a longstanding history in the healthcare industry, looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve.

How We Work

At Elevance Health, we are creating a culture that is designed to advance our strategy but will also lead to personal and professional growth for our associates. Our values and behaviors are the root of our culture. They are how we achieve our strategy, power our business outcomes and drive our shared success - for our consumers, our associates, our communities and our business.

We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few.

Elevance Health operates in a Hybrid Workforce Strategy. Unless specified as primarily virtual by the hiring manager, associates are required to work at an Elevance Health location at least once per week, and potentially several times per week. Specific requirements and expectations for time onsite will be discussed as part of the hiring process. Candidates must reside within 50 miles or 1-hour commute each way of a relevant Elevance Health location.

The health of our associates and communities is a top priority for Elevance Health. We require all new candidates in certain patient/member-facing roles to become vaccinated against COVID-19. If you are not vaccinated, your offer will be rescinded unless you provide an acceptable explanation. Elevance Health will also follow all relevant federal, state and local laws.

Elevance Health is an Equal Employment Opportunity employer and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws. Applicants who require accommodation to participate in the job application process may contact elevancehealthjobssupport@elevancehealth.comfor assistance. Apply Now