Senior Manager, Referral Services

7,000 Diseases - 500 Treatments - 1 Rare Pharmacy

PANTHERx is the nation’s largest rare disease pharmacy, and we put the patient experience at the top of everything that we do. 

If you are looking for a career in the healthcare field that embraces authentic dedication to patient care, you don’t need to look beyond PANTHERx. In every line of service, in every position and area of expertise, PANTHERx associates are driven to provide the highest quality outcomes for our patients.   

We are seeking team members who:

Are inspired and compassionate problem solvers;

Produce high quality work; 

Thrive in the excitement of the ever-challenging environment of modern medicine; and 

Are committed to achieving superior health outcomes for people living with rare and devastating diseases. 

At PANTHERx, we know our employees are the driving force in what we do. We cultivate talent and encourage growth within PANTHERx so that our associates can continue to explore their interests and expand their careers. Guided by our mission to provide uncompromising quality every day, we continue our strategic growth to further reach those affected by rare diseases.  

Join the PANTHERx team, and define your own RxARE future in healthcare!

Location: Pittsburgh, PA

Classification: Exempt

Status: Full-Time

Reports to: Vice President, Revenue Cycle Management

Purpose:

The Senior Manager, Referral Service provides support and guidance to the Referral Services department. This role communicates with staff to facilitate daily department functions and create a vision for the department and determine future needs.

Responsibilities:

• Provides strategic guidance as relates to benefits verification for new and existing programs.
• Serves as subject matter expert to the Pharmacy Operations Department representing benefits verifications processes.
• Monitors financial risks and profitability.
• Manages negotiation for letters of agreement.
• Assists with the Management of all assigned projects to the Revenue Cycle department.
• Works closely with Pharmacy Operations team on initiatives/new drug launches.
• Assists in the training and development of new hires within the Revenue Cycle team.  
• Serves as a liaison/mentor to the department.
• Develops and maintains SOP’s for the department.
• Assists with the implementation and roll out of new processes.
• Provides monthly and quarterly reporting on departmental metrics to Director.
• Supports any testing for new software enhancements.
• Other duties as assigned within scope of practice.

Required Qualifications:

• Bachelor’s degree in business administration, Healthcare Management, or related field or equivalent experience. 5 years of utilization management and Medicare and/or Medicaid insurance experience. 
• Working knowledge of Medicare and Medicaid managed care practices and policies and State Children's Health Insurance Program (SCHIP). 
• Previous experience as a lead in a functional area, managing cross-functional teams on large scale projects or supervisory experience including hiring, training, assigning work and managing the performance of staff.

Work Environment:

This job operates in a professional office environment. This role routinely uses standard office equipment such as computers, phones, photocopiers, filing cabinets and fax machines.

Physical Demands:

While performing the duties of this job, the employee is regularly required to talk or hear. The employee frequently is required to stand; walk; use hands and fingers, handle or feel; and reach with hands and arms. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential function of the job.

Benefits:

Hybrid, remote and flexible on-site work schedules are available, based on the position.  PANTHERx Rare Pharmacy also affords an excellent benefit package, including but not limited to medical, dental, vision, health savings and flexible spending accounts, 401K with employer matching, employer-paid life insurance and short/long term disability coverage, and an Employee Assistance Program!   Generous paid time off is also available to all full-time employees, as well as limited paid time off for part-time employees.  Of course we offer paid holidays too!

Equal Opportunity:

PANTHERx Rare Pharmacy is an equal opportunity employer, and does not discriminate in recruiting, hiring, promotions or any term or condition of employment based on race, age, religion, gender, ethnicity, sexual orientation, gender identity, disability, protected veteran's status, or any other characteristic protected by federal, state or local laws.