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Senior Manager, Medicare Utilization Management, Pharmacist

ManagerManagerFull TimeRemoteTeam 501-1,000Since 2017H1B No SponsorCompany Site LinkedIn

Location

United States

Posted

34 days ago

Salary

$150K - $160K / year

Bachelor Degree2 yrs expEnglish

Job Description

• Manage and optimize Medicare prior authorization and appeals processes • Ensure compliance with CMS guidelines while overseeing a dynamic team • Create and maintain policies, procedures, and job aids • Manage contracts with regulatory vendors • Oversee member and provider communications • Collaborate with internal stakeholders to support clinical operations • Drive team performance, provide training, and ensure adherence to compliance standards • Participate in goal setting and evaluate team performance • Generate and deliver reports on prior authorization

Job Requirements

2+ years of Medicare PA leadership experience required
Experience with managing large remote teams preferred
Medicare implementation experience preferred
4+ years of experience at a PBM or health plan preferred
Active, unrestricted, pharmacist license required
Exhibit strong written communication and oral presentation skills
Proficient in Microsoft office Suite with an emphasis on PowerPoint and Excel
Self-starter with the ability to work in a fast-paced environment with shifting priorities