Express Scripts Sr. Manager, Prior Authorizations in Whitestown, Indiana
The Sr. Manager, Prior Authorizations is primarily responsible for providing leadership to a team accountable for ensuring department compliance with all Federal and State regulations concerning Prior Authorizations . Work with Product, Express Scripts Compliance, Express Scripts Audit teams and Account Managers to guarantee compliance. Participate in client and regulatory audits of Prior Authorizations. Areas of responsibility include Case Turnaround Time, Chapter 13 and 18 Medicare Compliance, State Regulatory oversight, outbound calls and reporting on advocate errors tracking and trending, new client implementations, and client facing meetings to represent operations. Knowledge of the health insurance industry is strongly preferred.
- Responsible for managing and driving the execution of a portfolio of projects, delegating responsibility to team members, project support resources and site operational leaders for driving change management.
- Ensure quality and service standards are maintained along with client-specific contractual requirements.
- Oversees implementation of new clients.
- Foster ongoing client relationships by troubleshooting escalated issues.
- Develop and build leadership talent and capability within the team and direct reports.
- Provide stretch learning and development assignments to team members.
- Bachelor’s degree in related field or 14 to 18 years of experience.
- 8-12 years relevant experience with Bachelor’s Degree or Master’s degree and 6-10 years of relevant experience
- Knowledge of Health Insurance, Pharmacy Benefit Management, or Healthcare Industry strongly preferred.
- Operations knowledge and experience required – includes specific experience using data analytics and reporting as a means to manage
- Advanced problem solving skills with the ability to work cross-functionally to resolve issues and generate results among potentially conflicting constituencies; Analytical thinking, demonstrated ability to leverage data for problem solving; Basic financial analysis skills.
- Able to work towards specific deliverables within an environment of tight deadlines and significant pressure
- Demonstrated ability to delegate to direct and indirect reports, ability to focus on top priorities.
- Operational decision-making (staffing, demand planning, quality, etc).
- PC skills including proficiency in Microsoft office; Moderate relational database query skills (e.g., Access)
- Excellent communication skills, including written and verbal.
- Excellent customer service skills required.
ABOUT THE DEPARTMENT
The Pharmacy Operations Group is crucial to achieving our mission of helping to achieve a more sustainable health care system and better health for all. Members of this team are on the front line every day – interacting with patients, strategizing on improvements and efficiencies, and processing more than one million prescriptions that come through our world-class pharmacies and distribution facilities across the country.
ABOUT EXPRESS SCRIPTS
At Express Scripts, we dare to imagine a better health care system, and we’re driven to make it happen. Where some see obstacles, we see possibilities. We’re challengers, difference-makers and opportunity-seekers, united with our partners in pursuit of a simpler, more sustainable system and better health for all.
We have always acted first to take on the toughest challenges. We uniquely partner across the health care ecosystem to uncover opportunities, take action, advance health care and deliver better outcomes – like no one else can. We believe health care can do more. We are Champions For BetterSM.
Express Scripts, part of Cigna Corporation, unlocks new value in pharmacy, medical and beyond to further total health for all.