Manager, Clinical Pharmacy (Prior Authorization)- Remote!

Sentara
life insurance, vision insurance, parental leave, paid time off, sick time, tuition reimbursement, 401(k), 403(b)
United States, Virginia, Virginia Beach
Feb 04, 2025
City/State Virginia Beach, VA Overview Work Shift First (Days) (United States of America) Sentara Health Plans is hiring for a Manager, Clinical Pharmacy (Prior Authorization)- Remote! Status: Full-time, permanent position (40 hours) Work hours: 8am to 5pm EST, M-F Location: This position is fully remote for candidates that live in the following states: VA, NC, AL, DE, FL, GA, ID, IN, KS, LA, ME, MD, MN, NE, NV, NH, ND, OH, OK, PA, SC, SD, TN, TX, UT, WA, WV, WI, WY! Job Description Summary This position will manage and coordinate clinical pharmacy programs, including formulary and utilization management, reporting, outcomes assessment, and regulatory requirements. This position will report to the VP, Pharmacy- Sentara Health Plans and will require close collaboration with other management in the pharmacy department, as well as coordination with the health services team. This position will also be required to analyze systems, programs, and resources to maximize their effectiveness. This position will lead our clinical prior authorization operations workflows including electronic prior authorization build and staff management of 15 direct reports (Clinical Pharmacists) Required qualifications: Licensed in VA REQUIRED Pharmacist- 5 years experience REQUIRED Health Plan- 4 years experience REQUIRED Managed Care- 4 years experience REQUIRED Management- 1 year experience REQUIRED Pharmacy Benefit Manager- 4 years experience REQUIRED Benefits: Sentara offers an attractive array of full-time benefits to include Medical, Dental, Vision, Paid Time Off, Sick, Tuition Reimbursement, a 401k/403B , 401a, Performance Plus Bonus, Career Advancement Opportunities, Work Perks and more. Sentara Healthcare offers employees comprehensive health care and retirement benefits designed with you and your family's well-beingin mind. Ourbenefits packages are designed to change with you by meeting yourneeds now and anticipating what comes next. You have a variety of options for medical, dental and vision insurance, life insurance, disability and voluntary benefits as well as Paid Time Off in the form of sick time, vacation time and paid parental leave. Team Members have opportunity to earn an annual flat amount Bonus payment if established system and employee eligibility criteria is met. For applicants within Washington State, the following hiring range will be applied: $142,440.48 annually to $196,560.00 annually. Sentara Health Plans is the health insurance division of Sentara Healthcare. Sentara Health Plans provides health insurance coverage through a full suite of commercial products including consumer-driven, employee-owned and employer-sponsored plans, individual and family health plans, employee assistance plans and plans serving Medicare and Medicaid enrollees. With more than 30 years' experience in the insurance business and 20 years' experience serving Medicaid populations, we offer programs to support members with chronic illnesses, customized wellness programs, and integrated clinical and behavioral health services - all to help our members improve their health. Our success is supported by a family-friendly culture that encourages community involvement and creates unlimited opportunities for development and growth. Be a part of an excellent healthcare organization that cares about our People, Quality, Patient Safety, Service, and Integrity. Join a team that has a mission to improve health every day and a vision to be the healthcare choice of the communities that we serve! To apply, please go to www.sentaracareers.com and use the following as your Keyword Search: JR-72641 #LI-PM1 Talroo - Health Plan Pharmacy, Managed Care, PharmD, Licensed Pharmacist, Virginia, MCO, Health Plan, Healthcare, Remote, Prior Authorization, Pre Auth, Alabama, Delaware, Florida, Georgia, Idaho, Indiana, Kansas, Louisiana, Maine, Maryland, Minnesota, Nebraska, Nevada, New Hampshire, North Carolina, North Dakota, Ohio, Oklahoma, Pennsylvania, South Carolina, South Dakota, Tennessee, Texas, Utah, Virginia, Washington, West Virginia, Wisconsin, Wyoming Job Summary This position will manage and coordinate clinical pharmacy programs, including formulary and utilization management, medication therapy management, pharmacy care management, reporting, outcomes assessment, and regulatory requirements. This position will report to the Director Clinical Pharmacy and will require close collaboration with other management in the pharmacy department, as well as coordination with the health services team. The Manager Clinical Pharmacy will work with the Director of Clinical Pharmacy to provide input and implement a strategic plan for clinical pharmacy services. This includes maintenance of current clinical programs, and also identifying and implementing innovative clinical programs to decrease the total cost of care for our members. This position will also be required to analyze systems, programs, and resources to maximize their effectiveness. Required to be licensed in VA. Qualifications: BLD - Bachelor's Level Degree: Pharmacy (Required), MLD - Master's Level Degree: Pharmacy Pharmacist License (RPh) - State license - North Carolina Board of Pharmacy (NCBOP), Pharmacist License (RPh) - State license - Other/National, Pharmacist License (RPh) - State license - Virginia Department of Health Professionals (VADHP) Health Plan, Managed Care, Management, Pharmacist, Pharmacy Benefit Manager Skills Active Learning, Active Learning, Active Listening, Communication, Complex Problem Solving, Coordination, Critical Thinking, Judgment and Decision Making, Leadership, Learning Strategies, Mathematics, Mgmt of Financial Resources, Mgmt of Material Resources, Mgmt of Staff Resources, Microsoft Excel, Microsoft Word, Monitoring, Persuasion, Project Management, Quality Control Analysis, Reading Comprehension, Science, Service Orientation, Social Perceptiveness, Speaking {+ 5 more} Sentara Healthcare prides itself on the diversity and inclusiveness of its close to an almost 30,000-member workforce. Diversity, inclusion, and belonging is a guiding principle of the organization to ensure its workforce reflects the communities it serves. Per Clinical Laboratory Improvement Amendments (CLIA), some clinical environments require proof of education; these regulations are posted at ecfr.gov for further information. In an effort to expedite this verification requirement, we encourage you to upload your diploma or transcript at time of application. In support of our mission "to improve health every day," this is a tobacco-free environment.