Authorization remote

AMERIHEALTH CARITAS Remote
remote prior authorization pharmacy health regulatory mission management departmental people team managed care providers pharmacists
November 24, 2022
AMERIHEALTH CARITAS
Philadelphia, Pennsylvania
FULL_TIME

Your career starts now. We’re looking for the next generation of health care leaders.


At AmeriHealth Caritas, we’re passionate about helping people get care, stay well and build healthy communities. As one of the nation's leaders in health care solutions, we offer our associates the opportunity to impact the lives of millions of people through our national footprint of products, services and award-winning programs.


AmeriHealth Caritas is seeking talented, passionate individuals to join our team. Together we can build healthier communities.


If you want to make a difference, we’d like to hear from you.


Headquartered in Philadelphia, AmeriHealth Caritas is a mission-driven organization with more than 30 years of experience.


We deliver comprehensive, outcomes-driven care to those who need it most. We offer integrated managed care products, pharmaceutical benefit management and specialty pharmacy services, behavioral health services, and other administrative services.


Discover more about us at .


PerformRx is a Pharmacy Benefits Manager (PBM) dedicated to clinical culture, boutique service and holistic solutions. Our mission is to help clients, providers and members use effective medication therapy to improve health and wellness.


For over two decades, our focus has been on providing optimal service through a clinical culture which seeks to provide members with high quality care while ensuring our partners receive favorable costs.


That culture is reflected in our employees more than 80 percent of our staff members are Pharmacists and Pharmacy Technicians and in the services we provide.


PerformRx is headquartered in Philadelphia. Our dedication to innovation and to providing the most efficacious outcomes is the core of our clinical culture and is the heart of PerformRx.


PerformRx is a subsidiary of the AmeriHealth Caritas Family of Companies.


OPEN TO CANDIDATES NATIONWIDE


Summary :


As a licensed healthcare professional and member of the Prior Authorization Department management team, the Prior Authorization Pharmacist Supervisor’s primary responsibilities are to supervise the daily operations of the prior authorization Pharmacists and to respond to inquiries from other internal departments as well as external customers.


This includes oversight of staff to ensure appropriate coverage at all times to meet business needs and client / regulatory requirements.


Responsibilities include :



  • Coordinate training and guide development of new and existing staff including ensuring staff is properly oriented on departmental and company policies and procedures

  • Participate in the goal setting process and regularly review performance of direct reports, addressing performance and conduct issues when needed

  • Generate and regularly review phone, authorization, and prior authorization statistics and reports to ensure pharmacist staff adheres to internal / regulatory requirements and performance standards

  • Monitor and manage prior authorization and phone queues to ensure appropriate staff coverage to meet business needs

  • Develop and maintain departmental procedures and reference materials

  • Investigate / resolve escalated issues or problems from clients and Providers

  • Assist in new client implementations and other client / departmental initiatives

  • Support clients through attendance at client meetings and responding to client inquiries

  • Support internal and client accreditations and regulatory audits


  • Keep abreast of industry trends and regulatory changes in the pharmacy benefit management industry and evaluate their impact on Prior Authorization Department operations

  • Create and support an environment which fosters teamwork, cooperation, and respect and diversity

  • Establish and maintain positive communication and professional demeanor with ACFC employees and clients at all times

  • Demonstrate and support commitment to corporate goals and mission

  • Perform other job related duties and projects as assigned


Education / Experience :



  • Bachelor’s Degree required

  • RPh.; Pharm.D. preferred

  • Active / current Pharmacist License in applicable state is required

  • Minimum one (1) year of current / recent managed care experience required

  • Minimum three (3) years of current / recent pharmacy experience required

  • Proficient PC skills in a Windows based environment required

  • Last updated : 2022-11-24


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