Job Overview:The Clinical Coordinator Manager is responsible for leading a team of Clinical Coordinators who support the coverage determinations and appeals processes of SlateRx, LLC. This position will be responsible for the day-to-day activities of clinical operations, including efficiency, accuracy and timeliness of reviews.
Responsibilities:As a Clinical Coordinator Manager, your key responsibilities will include:
- Lead the Clinical Coordinator team, inclusive of hiring, coaching, and evaluating staff.
- Support and advise Clinical Coordinator Supervisors with member, client, and software issues.
- Handle escalated clinical issues, including escalated calls.
- Oversee the research claim reject messaging associated with coverage determination and appeal requests.
- Ensure response to routine inquiries and correspondence regarding coverage determinations and appeals with members, prescribers, and pharmacies is handled completely and appropriately as applicable.
- Ensure the coverage determination and appeals process from start to finish is being handled efficiently and requests are completed timely.
- Monitor and update Clinical Coordinator productivity reports.
- Oversee the Clinical Coordinator monthly schedules to ensure appropriate coverage for timely completion of coverage determinations and appeals, and answering of calls.
- Report accomplishments, infractions, and overall productivity to upper management.
- Oversee staff training on changing procedures and PA automation system.
- Conduct performance evaluations.
- Promote and foster a professional, positive, dynamic team environment through exemplary leadership.
- Mentor staff to improve skillset and career development.
- Advise on employee promotions, transfers and dismissals.
- Collaborate with cross-functional team leads to streamline and drive efficiencies in the coverage determination process.
- Perform miscellaneous job-related duties as assigned.
Qualifications:To excel in this role, you should possess the following qualifications:
- Knowledge of pharmacy benefit management, CDAG operational processes, and regulatory requirements.
- Computer and typing proficiency.
- Ability to adapt to a dynamic and fast-paced environment.
- Staff management experience.
- Possess excellent communication skills.
- A good educator who is trustworthy and willing to share information and serve as a mentor.
- Demonstrated ability to manage multiple priorities and deadlines.
- A well-organized and self-directed individual who is able to work with minimal amount of supervision.
- Capability to efficiently complete tasks in a demanding environment.
Education:High school diploma or GED required; Bachelor's degree strongly preferred.
License Requirement:Current and valid Pharmacy Technician Certification, Licensure, or Registration; OR a minimum of 8 years' experience with appropriate industry experience, preferably in the healthcare, insurance or PBM industry.
Job Benefits:Health, Dental, Vision, Life, 401k, Paid Time Off.
Location:Remote
