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CAMBIA HEALTH SOLUTIONS, INC. Supervisor Pharmacy Services Prior Authorization in SALT LAKE CTY, Utah

*Supervisor Pharmacy Services Prior Authorization*\ \ Remote ID, OR, UT, WA\ \ Primary Job Purpose\ \ The Supervisor Pharmacy Services Prior Authorization under guidance of Manager, Prior Authorization Operations, develops and initiates the direction, goals and objectives for department service levels to ensure the processing of prior authorization requests in compliance with policies and procedures. Ensures adherence to company and National Accreditation requirements. Coordinates and administers workflow. Monitors and audits production and performance of Pharmacy Prior Authorization staff, and generates routine reports.\ \ General Functions and Outcomes

  • Ensures proper training for all new and existing employees, including temporary employees and pharmacy intern students, as needed. Training sessions take place at Cambia offices in Oregon, Washington, Idaho and Utah.
  • Responsible for being knowledgeable about all contracts, drug programs and benefits, and to demonstrate the ability to administer policies consistently in accordance with contracts.
  • Provides ongoing performance feedback and professional development to each employee on a routine basis. This time is used to assist, motivate, and train employees to enable them to meet or exceed requirements and standards.
  • Responsible for maintenance of the department policies and procedures manual.
  • Updates Pharmacy PA communication tools, including PA database and letters.
  • Manages and directs workflow. Evaluates productivity and quality of work, and reports individual and department performance on a weekly and monthly basis.
  • Reviews volume and nature of workload handled by department staff. Presents recommendations to management to correct potential problems and identifies training/education opportunities. Communicates with other departments to resolve issues and provide training as needed.
  • Monitors status of department projects to ensure they are being managed according to department policies and procedures.
  • Conducts interviews and makes hiring decisions.
  • Conducts formal performance reviews.
  • Resolves intra-departmental conflicts and takes disciplinary action when necessary.
  • Communicates with employees in Marketing, Group Accounting, Claims and Customer Service to ensure the highest degree of subscriber service possible.
  • Performs detailed analyses of work processes and output in an effort to continuously improve both.
  • Coordinates special projects as requested by management.
  • Attends meetings as needed.
  • Facilitates department staff meetings on a regular basis. Provides information regarding new products and groups. Provides updates on corporate and/or department policy and procedure changes.
  • Tracks and approves the department bi-weekly time reporting system.

\ Minimum Requirements

  • Demonstrated knowledge of the health care industry with emp hasis on the pharmacy benefits management industry; medical terminology, pharmaceutical products, including orals, injectables, infusion products, and chemotherapy; health care coding systems such as ICD-9, CPT, and HCPCS. Experience with URAC, NCQA, and Medicare Part D regulations desirable.
  • Demonstrated proficiency in Microsoft Word and Excel and general office practices and procedures.
  • Demonstrated ability to create a unified, productive work environment for department staff.
  • Ability to prioritize individual and department workload including ability train new and existing employees on job requirements.
  • Demonstrated oral and written communication skills including ability to translate and present pharmacy & Rx benefit information in both formal and informal settings.
  • Manage production of training materials and documentation of department policies.
  • Maintain consistent professional, service oriented relations with all levels of employees.
  • Demonstrated versatility while performing tasks in a fast-paced, pressured environment.
  • Instruct, motivate, and direct individuals face-to-face, over the phone, or in written communications.
  • Demonstrated ability to use good judgment and problem solving skills including ability to exercise judgment in confidential and sensitive issues.
  • Demonstrated ability to adapt to change and coach employees on change management as necessary.
  • Ability to grasp new policies and procedures quickly.
  • Demonstrated ability to maintain attendance at or above the company standard.

\ Normally to be proficient in the competencies listed above\ \ The Supervisor Pharmacy Services Prior Authorization would have a Bachelor\'s degree in general education or related field with a minimum of six years of experience as a pharmacy technician in retail, hospital or other licensed pharmacy setting and three years of leadership experience either as a Pharmacy Tech Lead or other leadership role or an equivalent combination of education and experience.\ \ FTEs Supervised\ \ 7-15 staff\ \ #LI-Remote\ \ The expected hiring range for a Supervisor Pharmacy Services Prior Authorization is \$60,000 - \$82,000 depending on skills, experience, education, and training; relevant licensure / certifications; performance history; and work location. The bonus target for this position is 10%. The current full salary range for this role is \$56,500 - \$92,500.\ \ Base pay is just part of the compensation package at Cambia that is supplemented with an exceptional 401(k) match, bonus opportunity and other benefits. In keeping with our Cause and vision, we offer comprehensive well-being programs and benefits, which we periodically update to stay current. Some highlights:\ \

  • medical, dental, and vision coverage for employees and their eligible family members
  • annual employer contribution to a health savings account (\$1,200 or \$2,500 depending on medical coverage, prorated based on hire date)
  • paid time off varying by role and tenure in addition to 10 company holidays
  • up to a 6% company match on employee 401k contributions, with a potential discretionary contribution based on company performance (no vesting period)
  • up to 12 weeks of paid parental time off (eligible day one of employment if within first 12 months following birth or adoption)
  • one-time furniture and equipment allowance for employees working from home
  • up to \$225 in Amazon gift cards for participating in various well-being activities. for a complete list see our External Total Rewards page.

\ We are an Equal Opportunity and Affirmative Action employer dedicated to workforce diversity and a drug and tobacco-free workplace. All qualified applicants will receive consideration for employment without regard to race, color, national origin, religion, age, sex, sexual orientation, gender identity, disability, protected veteran status or any other status protected by law. A background check is required.\ \ If you need accommodation for any part of the application process because of a medical condition or disability, please email CambiaCareers@cambiahealth.com. Information about how Cambia Health Solutions collects, uses, and discloses information is available in our Privacy Policy. As a health care company, we are committed to the health of our communities and employees during the COVID-19 pandemic. Please review the policy on our Careers site.