This position provides administrative oversight and management of a site or line of business Prior Authorization (PA)/Utilization Management (UM) department responsible for managing the delivery of member and provider services. This position plays a key role in initiatives critical to Magellan in achieving revenue goals and operational objectives. The position requires communication and teamwork across internal departments (account management, implementations, IT, quality, specialty pharmacy), in order to achieve objectives and SLAs. This position is also accountable for hiring, developing, mentoring, training and retaining staff.
Manages the pre-authorization process and customer service requirements to ensure compliance, quality and customer service level agreements are met.
Manages and coordinates the activities of the team to efficiently manage the output of assigned tasks.
Monitors the performance of team members by means of reports and observation.
Assumes accountability for team conduct and productivity.
Monitors individual team member's attendance and reliability patterns.
Administers performance improvement or corrective action plans when needed.
Coaches, mentors and develops Team Leaders/Supervisors and staff with a focus on quality and accuracy of service.
Works across divisional lines to ensure staff is properly trained and issues needing resolution are addressed timely.
Creates a culture of support, accountability and continuous improvement.
In collaboration with the Training Department, plans and develops training programs for department staff.
As the end user and system expert, proactively suggests changes/updates to the prior authorization application that ensures maximum protocol adherence, documented medication savings, and increased health plan customer satisfaction.
Possesses financial responsibility for meeting administrative budgets and the creation of innovative efficiencies.
Assists divisional management with the implementation of improvement initiatives and new business implementations.
Partners with Account Management and business clients to improve communications and address issues that may arise.
For Managers assigned to Clinical Programs: Assists in completing calls for clinical, specialty clinical, account management and all other programs carried out by the clinical department. Assists in building out/organizing program protocol. Ensure all organizational documents are generated and cataloged according to internal protocols.
Other Job Requirements
Responsibilities
Excellent written and verbal communication skills.Working knowledge of Microsoft Office Product Suite. Comfortable and willing to learn new technology and software applications.Strong problem solving skills.3+ years' direct supervisory experience.For positions supporting Medicare Part B, requires 2+ years of experience in Medicare Part B.
General Job Information
Title
Manager, Clinical Pharmacy Operations MediCal
Grade
25
Work Experience - Required
Customer Service, Pharmacy, Supervisory
Work Experience - Preferred
Education - Required
Education - Preferred
Bachelors
License and Certifications - Required
License and Certifications - Preferred
CPT/ExCPT/LPT/PTCB/RPT, Pharmacy Technician, State Requirements - 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.
Magellan is the employer of choice for hard working people interested in making a difference in the health care industry and in the communities where we work and live. Our strong culture of caring is the common thread in both our business strategy and our work environment. We value professional growth and development, total health and wellness, rewards and recognition as well as employee unity. Magellan is a place where you can thrive.
Magellan is committed to providing equal employment opportunities to employees and applicants for employment without regard to race, color, creed, religion, sex, gender identity and expression, sexual orientation, marital status, age, national origin, ancestry, citizenship, physical or mental disability, disabled veteran or veteran of the Vietnam Era status, or any other factors protected by law.
Magellan is committed to meeting applicable Federal labor and employment law posting requirements by providing necessary posters in a format which is easily accessible and conspicuous to all applicants. Copies of applicable posters are accessible by clicking here (https://www.magellanhealth.com/media/760295/mg-federal-contractors-applicant-english.pdf) .
Warning: Employment Scam
It has come to our attention that a false representative is contacting potential candidates and offering them work at home positions with Magellan Health. -Interviews- are conducted completely through email and the false job offer includes the promise of a check to be issued to the candidate for the purposes of setting up a home office.
Please know that Magellan Health does not interview any candidate through email, nor do we issue checks to candidates to set up home offices. All of our available positions are posted on legitimate job boards and our recruitment team directly contacts candidates should there be a fit.
If you suspect you are being contacted by a false representative of Magellan Health, please call 410-953-2911
