Manager Pharmacy (Prior Authorizations)

A proud member of the Elevance Health family of companies, Paragon Healthcare brings over 20 years in providing life-saving and life-giving infusible and injectable drug therapies through our specialty pharmacies, our infusion centers, and the home setting.

Location: This position will work a Hybrid Model (remote and office). Ideal candidates must live within 50 miles or a 1 hour commute to the Elevance Health Office in Plano, Texas.

Work Shift Hours: Monday through Friday, Business Standard Hours (CST).

The Manager Pharmacy (Prior Authorizations) is responsible for managing a team of pharmacy associates who facilitate patient access to pharmaceutical therapy through the prior authorization process.

How you will make an impact:

• Ensures adherence to formulary and member benefit structures to provide service that is medically appropriate, high quality, and cost effective.

• Manages associates who assist providers gain authorizations for medications and determining appropriate routes of billing by utilizing the applicable medical policy and industry standards.

• Ensures the accurate interpretation of benefits and managed care guidelines along with guiding patients to appropriate programs or resources.

• Applies clinical knowledge to work with facilities and providers for care-coordination.

• Occasionally manages appeals for denied pharmacy services.

• Serves as the subject matter expert for other areas of the company and within the department.

• Develops and manages annual operating budget.

• Hires, trains, coaches, counsels, and evaluates performance of direct reports.

Minimum Requirements:

Requires BA/BS degree and a minimum of 2 years previous management experience; a minimum of 5 years customer service experience related to the provision of financial assistance or pharmacy billing ; or any combination of education and experience which would provide an equivalent background.

Preferred Skills, Capabilities and Experiences:

• People management experience leading a team.

• Work experience in healthcare in the area of infusion highly desired.