Manager I, Pharmacy Operations

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The Role

The Pharmacy Operations Manager plays a critical role in the management of the Pharmacy prior authorization process which encompasses staffing, workflow management, quality and production and reporting to ensure regulatory compliance and service excellence. Reporting to the Director, Pharmacy Operations and in partnership with the Clinical Manger, this role will have responsibility for the call center associates and supervisors to ensure strong performance to metrics, support corporate First Call Resolution goals and foster a culture of development and performance excellence.

This role is eligible for the Flex persona. This position can be fully remote, with expectations to work in our Hingham, MA office 2x per month. 

Major Responsibilities:

• Lead and motivate Pharmacy Operations team associates to ensure service excellence; provide ongoing coaching, performance management, training and development
• Develop and support team goals and objectives, work with associates to establish measurable individual performance goals and monitor progress toward achievement of goals on regular basis to ensure high standards are met, recognize success and coach to improve performance issues.
• Create processes to effectively improve production and operating efficiencies while maximizing member/provider satisfaction.
• Provide regular data and reports to assess team and individual metrics and in compliance with required reporting for NCQA, CMS and other stakeholders as needed.
• Evaluate, plan and mange staffing needs on ongoing basis according to Pharmacy program initiatives and benefit changes including forecasting temporary staffing needs.
• Lead the recruiting and training activities for full time and temporary staff and manage ongoing relationship with temporary staffing agencies.
• Facilitate team meetings for all lines of business.
• Manage staff of supervisors to provide day to day oversight of operations, reporting, workflow development and floor support.
• Contribute to a culture of service excellence by anticipating the needs of our providers and members and ensure the Pharmacy Operations team delivers a level of service consistent with the BCBSMA First Call Resolution goals.
• Support new clinical program implementation through partnership with Clinical Operations Manager.
• Represent the interest of our members and providers through active participation within various workgroups to ensure the success of the Pharmacy initiatives Responsible to maintain all regulatory requirements including, but not limited to, NCQA, MCRA, CMS for turnaround times, documentation, notifications and audit activities.
• Develop, implement and maintain all departmental Policy and Procedures and represent Pharmacy at monthly P&P meetings.
• Responsible for business oversight of after hours delegation program with PBM to ensure compliance with all NCQA requirements and to monitor service levels and quality of PBM staff.
• Research and manage to resolution escalated service issues with PBM mail order and customer service areas received from internal and external customers.
• Lead testing, training and implementation of new systems and periodic enhancements to existing platforms.
• Special projects as assigned

Qualifications (Knowledge, Skills, and Abilities):

• Ability to manage in call center environment: forecast and manage staffing needs, develop and monitor team and individual metrics, create and utilize reports to measure cost, quality and productivity, identify/ implement workflows and process improvements
• Excellent organizational, problem solving and communication skills
• Strong planning, prioritizing and execution skills as well as the ability to work independently to meet tight deadlines
• Demonstrated leadership skills and experience; ability to work cross-functionally, build consensus, coach and develop staff and build morale
• Knowledge BCBSMA Pharmacy systems preferred
• Experience with and a working knowledge of MS Office suite of application

Education/Relevant Experience:

• Bachelor’s Degree or equivalent working experience
• 3-5 years supervisory experience; call center management experience strongly preferred
• Strong written/verbal communication skills including presentation skills

Minimum Education Requirements:

High school degree or equivalent required unless otherwise noted above

Location

Hingham

Time Type

Full time

Salary Range: $75,060.00 - $91,740.00

The job posting