Clinical Account Manager

Magellan Health Services   •  

Denver, CO

Industry: Managed Care & Health Insurance

  •  

5 - 7 years

Posted 338 days ago


ESSENTIAL FUNCTIONS:
Customer Relationship:
- Supports the account management team in developing and maintaining a strategic business plan that fully reflects global customer?s business objectives and how the company's solutions align with those objectives and specifically guides the company's operational, financial, network, clinical and relationship initiatives.
- Understands the customer's structure and demonstrates the ability to apply this knowledge in business and retention planning for the client.
- Ensures Service Level Agreement performance, assurance of accuracy of claims payment and administrative policies, rate maximization through ongoing benefit analysis and adherence to requirements of the account?s legal/regulatory environment.
- Owns overall account satisfaction within the company as well as satisfaction with all specific areas particularly account management.
- Develops strong relationships which penetrate the customer at various levels from day to day contacts to senior leadership involving other internal staff to maintain multiple connections and strengthen the overall relationship.
- Develops strong relationships and contacts within the company that are supportive of the achievement of customer service requirements including attainment of performance guarantees and minimization of performance penalty expense.
- Ensures all Customer and Account-Facing services are provided in a consistent and timely fashion.
- Supports the Internal Customer Operating Model.
- Resolves or appropriately escalates customer service issues in conjunction with operations (claims, service, and systems).
- Provides mentoring to the account management team in effective problem solving and servicing of the account.
- Develop, introduces, and executes the customer governance process.
- Builds relationships and alliances with matrix partners.

Compliance:
- Coordinates with the compliance department on knowing and understanding regulations and the implication to customer impact.
- Maintains a client audit schedule to ensure a proactive approach in supporting critical client compliance.
- Coordinates all customer audit preparation and execution.
- Proactively communicates to internal and external contacts.
- Demonstrates thorough contract understanding and detailed knowledge of business requirements.
- Coordinates with legal to ensure contract compliance.

Reporting:
- Defines customer reports and ensure coordination with the client.
- Oversight of reporting calendar to ensure timely submission.
- Analyzes data and reporting and executive summary development.
- Prepares and supports presentation of customer reports with meaningful analytics, trending and recommendations for program improvement based on findings.
- Ensures all client reports have an executive summary and explanation of data.

Financial:
- Ensures revenue goals are met, cost of care and administrative expenses are managed and segment profit targets are achieved for assigned account (s).
- Demonstrate a thorough knowledge of Cost of Care and implications internally and for the client.
- Ensures performance standards are measurable and realistic to achieve and/or exceed to avoid penalties. Partners with Operations and Network on monitoring. Manages methodology, reporting and communications.
- Directly participates and supports manager on all renewal activities.
- Manages risks and develop opportunities associated with underwritten rates.

Up-Sell/Product/Growth:
- Analyzes account benefit and ability to apply this knowledge to growth.
- Drives up-sell and renewal activities across assigned account(s). Negotiates and/or supports negotiation of rates and contractual terms with customers that result in achieving segment profit targets and creatively adjusts features and service delivery models that increase efficiency and improve value to the customer and/or margin for the company.
- Identifies products and services that bring solutions to the customer based on a thorough understanding of the customer?s strategic business goals and the business needs.
- Demonstrates depth of knowledge of the company's products and how multiple products are interdependent within the customercontractdeliverables and outcomes.

Minimum Qualifications

Education

Bachelors: Pharmacy (Required), PharmD: Pharmacy

License and Certifications - Required

RPH - Registered Pharmacist - Pharmacy

License and Certifications - Preferred

PharmD - Doctor Of Pharmacy, State Licensure - Pharmacy

Other Job Requirements

Responsibilities

Current U.S. Pharmacist license.
+5 years experience in pharmacy, managed care or PBM with 2 years experience in a leadership role.
MBA or MHA degree highly preferred

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