What are the responsibilities and job description for the Manager, Clinical Quality Assurance - PBM position at The PHOENIX Health Search Group?
Description
Rapidly Growing Player in the Pharmacy Benefits Management (PBM) marketplace seeks a Manager, Clinical Quality Assurance who will act as subject matter expert on prior authorization and appeals operations that are compliant for multiple lines of business.
Some of the expected job functions include :
- Develop and maintain prior authorization policies and procedures for all lines of business compliant with federal, state, and other regulations
- Ensure prior authorization processes are adherent to URAC, NCQA, and other accrediting bodies
- Work with Commercial and Government PA managers to revise job aids, work instructions, verbiage templates and reference documents as needed
- Support PA team on CDAG, ODAG, and data validation audits
- Manage Quality Assurance pharmacists and technicians
- Works with Director, Prior Authorization on other responsibilities, projects, and initiatives as needed
The compensation plan includes a competitive salary ($145,000 - $155,000 d / o / e ), plus bonus and benefits.
This position can be filled “remotely”, or as “hybrid”, should the candidate live in the NYC-Metro area.
Requirements
The ideal candidate for this position has at least two (2) years of prior authorization review and / or appeals experience in the Medicare space.
Qualified candidates should send their resumes in MS Word format to : mail@phoenixhealthsearch.com
Salary : $145,000 - $155,000