Senior Manager Pharmacy Services

Description of Required Duties and Tasks:

Essential duties and responsibilities include the following:

• Manage the day-to-day operations of care coordinators including oversite of business functions and improvement in processes
• Coordinate communication and workflow efficiently between pharmacists, input, dispensing, formulary, and clinical services departments
• Interview or correspond with nursing facility staff and/or providers to resolve issues with pharmacy orders or procedures
• Compile, audit and analyze patient records to document data for cost control and care improvement efforts
• Assist with formulary analysis, implementation and compliance
• Assist with the monitoring of MAC pricing and other reimbursement efforts
• Serve as final point of escalation for insurance issues
• Coordinate facility satisfaction (including in-services and education) with facility services coordinators
• Assist in managing daily prescription workflow by reviewing daily batches to ensure proper adjudication
• Provide reporting and analysis on formulary compliance, prior authorizations, medication rejections, back-up charges and other facility charges
• Manage medication change requests to meet formulary guidelines
• Assist billing department with month-end processes and billing issues
• Assist accounting department with reimbursement questions and issues
• Recommend process and policy improvements to ensure quality of patient care and to increase revenue
• Analyze information gathered by investigation, report findings and present recommendations to senior management
• Compile weekly, monthly, quarterly reports; develop and maintain KPI's
• Active member of Pharmacy Compliance Committee
• Communicate information effectively to supervisor and others in a timely matter
• Maintain proficiency with computer systems
• Analyze processes and work with employees to develop and implement ways to improve internal and external quality and continually seek ways for improvement
• Maintain confidentiality of work-related information and materials in compliance with HIPAA regulations
• Adhere to the principles of the Employee Standards and Code of Conduct and reports any violations
• Knowledgeable and compliant with current company policies and procedures and state and federal regulations
• Attend meetings and in-services as required
• Other duties as assigned

Required Knowledge:

• Work requires knowledge of the pharmacy industry, Medicaid Regulations, CMS and other state/federal regulations

Required Skills:

• Must possess required skills and be able to explain and demonstrate, with or without reasonable accommodations, that the essential functions of the job can be performed
• Maintaining an established work schedule
• Effectively using interpersonal and communications skills including tact and diplomacy
• Effectively using organizational and planning skills with attention to detail and follow through
• Establishing and maintaining effective working relationships
• Effectively demonstrates accuracy and thoroughness and continually strives to improve quality standards

Required Work Experience:

• Five (5) to ten (10) years of progressive management experience preferably in a healthcare setting
• Three (3) years of Medicare reimbursement experience

Required Computer Skills:

• Framework LTC Software System
• Framework ECM Software System

Equipment Used

• Standard Office Equipment
• Computer

Physical Requirements:

Required

• Occasional lifting of objects up to 40 pounds
• Subject to standing, walking, sitting, bending, reaching, kneeling, pushing and pulling
• Work is performed in a standard office environment
• Must have reliable transportation

Certification Requirements:

• Licensed Practical Nurse (LPN), Registered Nurse (RN) preferred

Education Requirements:

• Graduate of an accredited School of Nursing
• Or equivalent combinations of education and/or experience

Required Safety Expectations:

• Working safely and follow safety rules
• Report unsafe working conditions and behavior
• Take reasonable and prudent actions to prevent others from engaging in unsafe practices

EQUAL OPPORTUNITY EMPLOYER

This Organization is an equal opportunity employer. We do not discriminate based on race, color, religion, sex, handicap, disability, age, marital status, sexual orientation, national origin, veteran status, or any other characteristic(s) protected by federal, state, and local laws. This Organization will make reasonable accommodations for qualified individuals with disabilities should a request for an accommodation be made. A key part of this policy is to provide equal employment opportunity regarding all terms and conditions of employment and in all aspects of a person's relationship with the Organization including recruitment, hiring, promotions, upgrading positions, conditions of employment, compensation, training, benefits, transfers, discipline, and termination of employment.

This employer participates in E-Verify.