Manager (Prior Authorizations)- Clinical Operations (ORLANDO) - EmpiRx Health
Orlando, FL 31118
About the Job
Who We Are:
EmpiRx Health is the leading clinically-driven pharmacy benefits management company. As the pioneer in value-based pharmacy care, EmpiRx Health puts its customers and members first by enabling them to take control of their pharmacy benefits, healthcare outcomes, and financial results.
What We Do:
We place more emphasis on member care than any other PBM by focusing on health outcomes first. Our pharmacists and clinicians are at the center of everything we do―and our population health solution delivers tailored strategies for our clients.
Leveraging our newly launched, AI-powered pharmacy care platform, Clinically™, EmpiRx Health’s pharmacists and client management teams provide the highest quality pharmacy care to our clients and their members. This enables benefits plan sponsors to keep their members healthy, happy, and productive, while substantially reducing prescription drug spending, which has been on an explosive growth trajectory in recent years.
Who We're Looking For:
EmpiRx Health is experiencing unprecedented growth, and we are looking for an exceptionally skilled and experienced Clinical Operations Manager to assume a crucial role in leading the Clinical Operations team and serving as the company's subject matter expert on operations support, including adjudication platform, clinical review operations and processes.
If you are a highly motivated Clinical Operations Manager, with a strong background in adjudication system related to claims processing and clinical review requirements and are driven to make a meaningful impact in the healthcare industry, we encourage you to apply.
What You'll Do:
As a Clinical Operations Manager, your role will encompass a wide range of responsibilities including the below:
EmpiRx Health is an equal opportunity employer. We are committed to creating a diverse and inclusive environment for all employees. We prohibit discrimination and harassment of any kind based on race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state, or local laws.
All employment decisions are based on business needs, job requirements, and individual qualifications. We are an inclusive organization and actively promote equality of opportunity for all with the right mix of talent, skills and potential. EmpiRx Health celebrates diversity and is committed to creating an inclusive environment for all employees.
Your career at EmpiRx Health awaits – join us in shaping the future of excellence in healthcare.
Careers - EmpiRx Health
*No recruiters, please*
EmpiRx Health is the leading clinically-driven pharmacy benefits management company. As the pioneer in value-based pharmacy care, EmpiRx Health puts its customers and members first by enabling them to take control of their pharmacy benefits, healthcare outcomes, and financial results.
What We Do:
We place more emphasis on member care than any other PBM by focusing on health outcomes first. Our pharmacists and clinicians are at the center of everything we do―and our population health solution delivers tailored strategies for our clients.
Leveraging our newly launched, AI-powered pharmacy care platform, Clinically™, EmpiRx Health’s pharmacists and client management teams provide the highest quality pharmacy care to our clients and their members. This enables benefits plan sponsors to keep their members healthy, happy, and productive, while substantially reducing prescription drug spending, which has been on an explosive growth trajectory in recent years.
Who We're Looking For:
EmpiRx Health is experiencing unprecedented growth, and we are looking for an exceptionally skilled and experienced Clinical Operations Manager to assume a crucial role in leading the Clinical Operations team and serving as the company's subject matter expert on operations support, including adjudication platform, clinical review operations and processes.
If you are a highly motivated Clinical Operations Manager, with a strong background in adjudication system related to claims processing and clinical review requirements and are driven to make a meaningful impact in the healthcare industry, we encourage you to apply.
What You'll Do:
As a Clinical Operations Manager, your role will encompass a wide range of responsibilities including the below:
- Responsibilities:
- Function as the main point of contact for Clinical Concierge Services, ensuring the team effectively manages their caseload with timely and accurate execution while meeting their designated Key Performance Indicators (KPIs) and metrics.
- Manage the day-to-day functions within the Clinical Operations team and lead team’s development towards delivering exceptional white-glove service.
- Serve as a subject matter expert on the adjudication system related to claims processing and clinical review processes.
- Ensure that daily processes and protocols are followed for case management and new staff training.
- Assist with handling escalations that cannot be resolved by the team or require supervisory action.
- Monitor the workload capacity of the Clinical Operations team and ensure their performance aligns with organizational KPIs.
- Ensure that best practices are maintained within the team to provide consistent high-quality concierge services.
- Provide effective support to the team as needed, including coverage and other responsibilities.
- Serve as escalation point in the absence of the Director of Clinical Operations.
- What You Need:
- BS (Bachelor’s) Required
- Minimum 5 years of people management experience
- Minimum 5 years of pharmacy experience
- Minimum 5 years of experience in PBM, health plan, or equivalent
- Claim adjudication experience preferred
- Remote people management preferred
- EmpiRx Health is on an extraordinary journey where excellence meets innovation.
- We are a collaborative team that encourages groundbreaking ideas, values open dialogue, and prioritizes continuous improvement.
- You will be part of a dynamic team where success is a shared celebration, collaboration fuels progress, and we redefine healthcare together.
- We offer a generous and competitive benefits package.
- You will share in the company's success through our discretionary bonus program.
EmpiRx Health is an equal opportunity employer. We are committed to creating a diverse and inclusive environment for all employees. We prohibit discrimination and harassment of any kind based on race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state, or local laws.
All employment decisions are based on business needs, job requirements, and individual qualifications. We are an inclusive organization and actively promote equality of opportunity for all with the right mix of talent, skills and potential. EmpiRx Health celebrates diversity and is committed to creating an inclusive environment for all employees.
Your career at EmpiRx Health awaits – join us in shaping the future of excellence in healthcare.
Careers - EmpiRx Health
*No recruiters, please*
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Source : EmpiRx Health