Team Leader

2 weeks ago

Manila, National Capital Region, Philippines Access Healthcare Services Manila, Inc. Full time

Access Healthcare is looking for a highly skilled Team Leader to oversee operations for our Pharmacy Utilization account based in Taguig City. The ideal candidate must be a Licensed Pharmacist with extensive experience managing U.S. healthcare accounts, particularly in pharmacy utilization management, prior authorization, and compliance. This role requires strong leadership, process expertise, and the ability to drive performance while ensuring compliance with healthcare regulations.

Key Responsibilities:

  • Lead and manage a team handling pharmacy utilization review, prior authorizations, and medication coverage determinations.
  • Ensure adherence to U.S. healthcare regulations, pharmacy benefit management (PBM) guidelines, and client protocols.
  • Monitor KPIs, service level agreements (SLAs), and quality metrics, ensuring the team meets performance targets.
  • Provide coaching, training, and mentorship to enhance team expertise in pharmacy utilization management.
  • Collaborate with clients, stakeholders, and internal teams to optimize processes and improve operational efficiency.
  • Ensure compliance with HIPAA, CMS, and other regulatory requirements.
  • Analyze trends and process gaps to drive improvements in operational workflows and customer service delivery.
  • Handle escalations and complex cases, providing guidance on medication utilization reviews and prior authorization approvals.
  • Participate in strategy meetings, performance reviews, and process improvement initiatives to enhance service quality.

Qualifications:

  • Must be a Licensed Pharmacist.
  • Extensive experience in U.S. healthcare accounts, specifically in pharmacy utilization management, prior authorizations, and formulary compliance.
  • 3+ years of experience in a supervisory or team leadership role within a BPO healthcare setting.
  • Strong understanding of pharmacy benefit management (PBM), claims processing, and medication guidelines.
  • Excellent leadership, communication, and problem-solving skills.
  • Ability to handle high-pressure environments and drive team performance.
  • Proficiency in healthcare systems, EMR/EHR platforms, and pharmacy-related software is a plus.
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