System Manager-Pharmacy, Infusion Prior Authorization

It's more than a career, it's a calling.

MO-SSM Health Mission Hill

Worker Type:

Regular

Job Summary:

Responsible for managing the pharmacy infusion prior authorization department to ensure the timely submission of infusion prior authorizations and prevention of revenue loss due to denials. Manages a team of pharmacy access specialists in the day-to-day operations of applicable services and scope of work across the health system. Collaborates with ministry, regional, and system leaders to ensure policies and processes are in place for safe, effective, and fiscally responsible pharmacy infusion services.

Job Responsibilities and Requirements:

PRIMARY RESPONSIBILITIES 

• Leads and develops the infusion prior authorization processes and systems to maximize service, data integrity, and staff productivity/quality to achieve departmental goals and process outcomes. 
• Acts as primary liaison to ministry infusion departments to communicate root causes of denial and provides direction to mitigate denials in the future. 
• Resolves problems and rectifies inefficiencies related to infusion prior authorizations and denials. 
• Prepares service level metrics and interpretations for pharmacy leadership and supports health system key performance indicators (KPIs).  
• Assists with the identification of training needs and coordinates with responsible parties to develop and conduct training programs, including on-the-job training. 
• Maintains a thorough knowledge of applicable federal, state, and local laws and regulations, as well as other policies and procedures in order to ensure adherence in a manner that reflects honest, ethical, and professional behavior. 
• Manages budgeting and strategic planning. 
• Recruits, engages, develops, leads, and manages assigned staff.   
• Works in a constant state of alertness and safe manner.
• Performs other duties as assigned. 

EDUCATION 

• Pharmacy degree (PharmD; Bachelor of Pharmacy) from an accredited school of pharmacy

EXPERIENCE 

• Two years’ experience, with demonstrated leadership responsibility

PHYSICAL REQUIREMENTS

• Frequent lifting/carrying and pushing/pulling objects weighing 0-25 lbs.
• Frequent sitting, standing, walking, reaching and repetitive foot/leg and hand/arm movements.
• Frequent use of vision and depth perception for distances near (20 inches or less) and far (20 feet or more) and to identify and distinguish colors.
• Frequent use of hearing and speech to share information through oral communication. Ability to hear alarms, malfunctioning machinery, etc.
• Frequent keyboard use/data entry.
• Occasional bending, stooping, kneeling, squatting, twisting and gripping.
• Occasional lifting/carrying and pushing/pulling objects weighing 25-50 lbs.
• Rare climbing.

REQUIRED PROFESSIONAL LICENSE AND/OR CERTIFICATIONS
 
State of Work Location: Illinois

•     Pharmacist, Registered - Illinois Department of Financial and Professional Regulation (IDFPR)

     
State of Work Location: Missouri

•     Pharmacist - Missouri Division of Professional Registration

     
State of Work Location: Oklahoma

•     Pharmacist - Oklahoma State Board of Pharmacy

     
State of Work Location: Wisconsin

•     Pharmacis