Pharmacy Utilization Lead
2 days ago
We are looking for a seasoned professional to take on the role of Team Leader at Access Healthcare Services Manila, Inc. This individual will be responsible for overseeing the operations of our Pharmacy Utilization account and ensuring that our team delivers exceptional results.
The ideal candidate will have a strong background in pharmacy utilization management, prior authorization, and compliance. They will also possess excellent leadership and communication skills, as well as the ability to analyze trends and process gaps to drive improvements in operational workflows and customer service delivery.
Responsibilities:
- Lead a team of professionals handling pharmacy utilization review, prior authorizations, and medication coverage determinations.
- Ensure adherence to U.S. healthcare regulations, PBM guidelines, and client protocols.
- Monitor KPIs, SLAs, and quality metrics to ensure team performance targets are met.
- 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.
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 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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