Supervisor, Clinical Prior Authorization (RPh)

Navitus

Navitus - Putting People First in Pharmacy - Navitus was founded as an alternative to traditional pharmacy benefit manager (PBM) models. We are committed to removing cost from the drug supply chain to make medications more affordable for the people who need them. At Navitus, our team members work in an environment that celebrates diversity, fosters creativity and encourages growth. We welcome new ideas and share a passion for excellent service to our customers and each other.

USD $112,640.00 - USD $140,799.00 /Yr.

M-F 8am to 5pm CST

Navitus Health Solutions is seeking a Supervisor, Clinical Prior Authorization to join our Prior Authorization department!

 

The Supervisor, Clinical Prior Authorization (PA) is responsible for supervision of a group of Clinical PA pharmacists and will have expanded responsibility for select administrative PA functions. The expanded scope may include but not limited to client facing responsibilities for PA, clinical oversight of clinical edit administration, denial language and PA form oversight, and regulatory awareness. The supervisor will lead the Medical Exception meetings and will participate in other enterprise-wide clinical meetings such as Formulary Advisory Committee, the Navitus Pharmacy &Therapeutics Committee and client specific workgroup meetings as assigned by the Manager of Prior Authorization. In conjunction with the Manager, this position will be responsible for analyzing available data and providing prior authorization staffing, workflow, and system enhancement recommendations. The Supervisor will coordinate with Clinical Account Executives and Program Managers to enhance their support and understanding of PA programs. Additionally, the Clinical Pharmacist will develop and maintain appropriate clinical, evidence-based documentation that supports PA programs.  

 

Is this you? Find out more below!  

How do I make an impact on my team?

• Responsible for RPH schedule development and management.
• Support on-going training of current staff and the onboarding of new Clinical PA Pharmacists.
• Serve as clinical lead with support of PA Product / Program Manager to assure PA form development, accuracy, implementation, and use.
• Responsible for team leadership, assuring positive team dynamics to meet PA departmental goals. 
• Provide oversight/ audits to assure RPH decision quality aligns with quality standards, client expectations and regulations. 
• Review and recommend PA software/systems enhancements to increase efficiency.
• Develops and maintains policy and procedure documentation in concert with PA Program Manager.
• Develop thorough understanding of PA regulatory requirements and assures dissemination to the PA team.
• Responsible for assisting CAE pharmacists in the creation of communication and educational information to clients regarding prior authorization.
• Responsible for staying current with clinical literature and guidelines, and disseminating to Navitus core teams and program managers.
• Limited on-call and Saturday coverage as business needs dictate
• Other duties as assigned 

What our team expects from you?

• A minimum of a bachelor’s degree in Pharmacy or Pharm. D. Current unrestricted licensure as an RPh in their Home State or the ability to gain reciprocity within 4 months of employment is required. Other State Pharmacy Licenses may be required as business need dictates.
• Minimum three years clinical experience and a minimum of 6 months of PBM/Managed Care experience preferred
• Exceptional clinical skills and ability to apply sound clinical judgment to a variety of situations is necessary
• Proficiency in drug literature and clinical trial evaluation, including proficiency with electronic databases (e.g., Micromedex, Medline, Internet) required
• Ability to reason and translate clinical information into a manner appropriate for clinical systems and clinical/non-clinical audiences
• Emphasis on problem-solving skills, including identifying and accepting a challenging situation and creating and implementing a solution
• Requires attention to details to assure projects are clinically, editorially, and systems accurate and can be operationalized
• Proficiency in MS Word, Excel, PowerPoint including tables, charts and figures preferred
• Participate in, adhere to, and support compliance program objectives 
• The ability to consistently interact cooperatively and respectfully with other employees 

What can you expect from Navitus? 

• Top of the industry benefits for Health, Dental, and Vision insurance 
• 20 days paid time off 
• 4 weeks paid parental leave 
• 9 paid holidays 
• 401K company match of up to 5% - No vesting requirement 
• Adoption Assistance Program 
• Flexible Spending Account 
• Educational Assistance Plan and Professional Membership assistance 
• Referral Bonus Program – up to $750! 

We are unable to offer remote work to residents of Alaska, Hawaii, Maine, Mississippi, New Hampshire, New Mexico, North Dakota, Rhode Island, South Carolina, South Dakota, West Virginia, and Wyoming. 

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