Manager Pharmacy Prior Authorizations

Be Part of an Extraordinary Team

BioPlus Specialty Pharmacy is now part of CarelonRx (formerly IngenioRx), and a proud member of the Elevance Health family of companies. Together, CarelonRx and BioPlus offer consumers and providers an unparalleled level of service that's easy and focused on whole health. Through our distinct clinical expertise, digital capabilities, and broad access to specialty medications across a wide range of conditions, we deliver an elevated experience, affordability, and personalized support throughout the consumer's treatment journey.

LOCATION: Candidates must reside within 50 miles or 1-hour commute each way of 1831 Chestnut St, St Louis, MO 63103

SHIFT : Monday-Friday (occasional weekends if needed). Rotating schedule between 8-5 & 10-7

Build the Possibilities. Make an Extraordinary Impact.

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:

Primary duties may include, but are not limited to:

• 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 and 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:

• Previous pharmacy leadership experience preferred.

• Pharmacy prior authorization experience strongly preferred.