This position provides administrative oversight and management of a site or line of business Prior Authorization (PA)/Utilization Management (UM) department responsible for managing the delivery of member and provider services. This position plays a key role in initiatives critical to Magellan in achieving revenue goals and operational objectives. The position requires communication and teamwork across internal departments (account management, implementations, IT, quality, specialty pharmacy), in order to achieve objectives and SLAs. This position is also accountable for hiring, developing, mentoring, training and retaining staff.
- Manages the pre-authorization process and customer service requirements to ensure compliance, quality and customer service level agreements are met.
- Manages and coordinates the activities of the team to efficiently manage the output of assigned tasks.
- Monitors the performance of team members by means of reports and observation.
- Assumes accountability for team conduct and productivity.
- Monitors individual team member’s attendance and reliability patterns.
- Administers performance improvement or corrective action plans when needed.
- Coaches, mentors and develops Team Leaders/Supervisors and staff with a focus on quality and accuracy of service.
- Works across divisional lines to ensure staff is properly trained and issues needing resolution are addressed timely.
- Creates a culture of support, accountability and continuous improvement.
- In collaboration with the Training Department, plans and develops training programs for department staff.
- As the end user and system expert, proactively suggests changes/updates to the prior authorization application that ensures maximum protocol adherence, documented medication savings, and increased health plan customer satisfaction.
- Possesses financial responsibility for meeting administrative budgets and the creation of innovative efficiencies.
- Assists divisional management with the implementation of improvement initiatives and new business implementations.
- Partners with Account Management and business clients to improve communications and address issues that may arise.
- For Managers assigned to Clinical Programs: Assists in completing calls for clinical, specialty clinical, account management and all other programs carried out by the clinical department. Assists in building out/organizing program protocol. Ensure all organizational documents are generated and cataloged according to internal protocols.
Bachelors: Pharmacy (Required)
License and Certifications - Required
License and Certifications - Preferred
CPT/LPT/PTCB/RPT, Pharmacy Technician, State Requirements - Pharmacy
Other Job Requirements