Operations Manager

3 days ago


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

At Access Healthcare Services Manila, Inc., we are seeking a highly skilled Team Leader to oversee operations for our Pharmacy Utilization account based in the Philippines. 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.

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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