This position has managerial and clinical oversight of the Clinical Pharmacist and Registered Nurse Review Team, playing a key role in medical and pharmacy management. Leads and grows the clinical performance of a team of Clinical Pharmacist and Nurse Reviewers while supporting and enhancing provider experiences, meeting service level agreements, exceeding client expectations, and achieving revenue goals and operational objectives. Responsible for day-to-day tactical activities, performance trending, performance managing/coaching/developing clinical pharmacists/nurses and time management. Responsible for the delivery of superior customer service by maximizing employee clinical performance and ensuring calls are answered effectively and efficiently by supervising inbound and outbound calls, resolving escalated calls, assisting pharmacists/nurses with clinical and/or client related questions, auditing clinical notations for accuracy, ensuring agents adherence to schedules and ensuring compliance to policies, regulations, and procedures. Motivates agents to peak performance through positive coaching, constructive feedback and incentives, demonstrates a commitment to the company's mission and vision, and supports activities that strengthen the client relationship and grow the organization.
Drives the daily performance of a team of Clinical Pharmacist and Registered Nurse Reviewers ensuring clinical criteria is accurately collected, notated, and recommendations appropriately made.
Provides feedback and improvements in daily workflow with technicians/nurses/pharmacists.
Collects and provides timely, productive and measurable feedback to ensure recognition, process changes and development opportunities are maximized.
Oversees the team's annual goal setting process, performance evaluations and performance improvement plans, and ensures other business targets are met and exceeded.
Reviews new and updated client accounts, medications and policies with pharmacists.
Ensures compliance with clinical policies and procedures.
Provides direction on achieving departmental standards while encouraging and motivating them in promoting customer loyalty, employee recognition, and revenue generation.
Monitors inbound and outbound call traffic and makes adjustments based on call traffic patterns.
Actively participates in process/project conversations, emails and activities that will improve effectiveness/experience for client, agents, leadership, brands or partner departments
Displays ownership and accountability for the customer experience, employee relations, core business metric targets/contributing factors and understanding of the organizations policies and procedures.
Supports team members, business and brand initiatives, especially as related to achieving outstanding client experiences, including engaged daily support, escalated customer resolution and engagement in training and support areas as needed.
Maintains reliability and flexibility to ensure team and business needs are appropriately supported.
Proactively addresses call center concerns and identifies areas of opportunity.
Monitors agents for quality and training purposes.
Handles system emergencies with direction from IT department and/or appropriate vendor.
Daily authorization reviews, taking into account health plan requirements, including, but not limited to turn around times, type and number of outreaches made, review times, and regulations.
Coordinates with Initial Review Pharmacy Technician team as needed.
Produces monthly team reports detailing team activity, trend analysis, goals/objective status and special projects, as needed.
Other duties as assigned.
Other Job Requirements
Responsibilities
5+ years of clinical pharmacy experience.
Managed care pharmaceutical service experience plus experience with coaching physicians and prescribers on medication issues, especially on specialty medications.
Knowledge of current clinical research related to specialty medications.
Strong clinical research and implementation skills in practical settings.
Analytic skills which can translate into practical and pragmatic recommendations.
Strong clinical expertise to aid in enhancing the team's clinical skills and knowledge
Strong team orientation with respect for all members.
Strong verbal and written communications skills.
People skills are essential that allow for the successful consultation with physicians, prescribers and pharmacists and for successful collaboration with company employees and external vendors who do not directly report to this job.
Must be comfortable with using computers and the internet
Basic skills with Microsoft office products and ability to quickly learn proprietary systems.
General Job Information
Title
Supervisor, Clinical Pharmacist Reviewer MediCal
Grade
30
Work Experience - Required
Clinical, Pharmacy
Work Experience - Preferred
Speciality Pharmacy
Education - Required
Bachelors - Pharmacy
Education - Preferred
PharmD - Pharmacy
License and Certifications - Required
RPH - Registered Pharmacist - Pharmacy
License and Certifications - Preferred
PharmD - Doctor Of Pharmacy, State Licensure - Pharmacy
Magellan Health, Inc. is proud to be an Equal Opportunity Employer and a Tobacco-free workplace. EOE/M/F/Vet/Disabled.Every employee must understand, comply with and attest to the security responsibilities and security controls unique to their position; and comply with all applicable legal, regulatory, and contractual requirements and internal policies and procedures.
