Anthem, Inc. Manager Pharmacy Clinical Operations in Downey, California
SHIFT: Day Job
CareMore and Aspire Health are entering a new growth phase, as a proven care delivery model for the highest-risk. We are a team of committed clinicians and business leaders passionate about transforming American healthcare delivery. We build and lead integrated, multi-disciplinary clinical teams to care for the most complex patients and currently serve nearly 200,000 patients in 30+ states across Medicare, Medicaid, and commercial populations. We strive for excellence and have achieved significant and measurable improvement in total cost of care, clinical outcomes, and experience. As an Anthem subsidiary, we benefit from the scale and resources one of America’s largest managed healthcare organizations.
Responsible for developing and implementing clinical pharmacy programs to promote quality and cost-effective drug utilization. Primary duties may include, but are not limited to:
Assists in the development of new clinical products.
Oversees the Prior Authorization Center.
Implements new prior authorization program.
Manages clinical pharmacy operations and staff to insure clients' objectives and deliverables are met.
Oversees departmental processes, policies and procedures, training, and communication.
Reports and analyzes prior authorization program trends.
Ensures achievement of department goals and objectives.
Hires, trains, coaches, counsels, and evaluates performance of direct reports.
Requires at least a Bachelor’s degree in Pharmacy or a PharmD;
Must possess an active unrestricted state license or certification to practice pharmacy within the scope of practice in a state or territory of the United States (Rph).
Unless expressly allowed by state or federal law, or regulation, must be located in a state or territory of the United States when conducting utilization review or an appeals consideration and cannot be located on a US military base, vessel or any embassy located in or outside of the United States, and 5 years of experience in managed care, authorization, or related pharmacy experience; or any combination of education and experience, which would provide an equivalent background. PharmD preferred.
For URAC accredited areas the following applies: Requires strong oral, written and interpersonal communication skills, problem-solving skills, facilitation skills, and analytical skills.
Anthem, Inc. is ranked as one of America’s Most Admired Companies among health insurers by Fortune magazine and is a 2018 Diversity Inc. magazine Top 50 Company for Diversity. To learn more about our company and apply, please visit us at careers.antheminc.com. An Equal Opportunity Employer/Disability/Veteran.