Healthcare Team Lead
2 weeks ago
We are looking for a talented Team Leader to join our team at Access Healthcare Services Manila, Inc.
The successful candidate will have extensive experience in pharmacy utilization management, prior authorizations, and compliance, as well as excellent leadership and communication skills.
In this role, you will lead and manage a team handling pharmacy utilization review, prior authorizations, and medication coverage determinations. You will also ensure adherence to U.S. healthcare regulations, pharmacy benefit management (PBM) guidelines, and client protocols.
Key Responsibilities:
- Manage a team of professionals handling pharmacy utilization review, prior authorizations, and medication coverage determinations.
- Develop and implement strategies to improve team performance and compliance with healthcare regulations.
- Collaborate with clients, stakeholders, and internal teams to optimize processes and improve operational efficiency.
- 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.
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.
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