PBM Clinical Coordinator Supervisor

TriNet Group; Las Vegas (NV); On-site; USD 65,000 - 90,000; Full time

Job summary

SlateRx is seeking a Clinical Coordinator Supervisor to oversee the coverage determination and appeals clinical coordinator team, ensuring efficient, accurate, and timely reviews. You will supervise day-to-day operations, hire and coach staff, and resolve complex issues while maintaining high-quality service for plan sponsors and members.

Ideal candidates bring pharmacy benefit management knowledge, strong analytical and leadership skills, and the ability to mentor staff in a fast-paced

Qualifications

• Knowledge of pharmacy benefit management, CDAG operational processes, and regulatory requirements.
• Strong analytical skills with experience in data-driven decision-making.
• Excellent communication, coaching, and conflict-resolution skills.
• Computer and typing proficiency.
• Ability to adapt to a dynamic and fast-paced environment.
• A good educator who is trustworthy and willing to share information and serve as a mentor.
• Demonstrated ability to manage multiple priorities and deadlines.
• A well-organized and self-directed individual who is able to work with minimal supervision.

Responsibilities

• Lead, coach, and mentor team members to achieve personal and professional growth.
• Oversee day-to-day team operations, ensuring alignment with business objectives.
• Lead the Clinical Coordinator team, inclusive of hiring, coaching, and evaluating staff.
• Support and advise clinical coordinators with member, client, and software issues.
• Handle escalated clinical issues, including escalated calls.
• Monitor and update daily productivity reports.
• Develop Clinical Coordinator monthly schedules to ensure appropriate coverage.
• Report accomplishments, infractions, and overall productivity to upper management.
• Train and update staff on changing procedures and PA automation system.
• Conduct performance evaluations.
• Promote and foster a professional, positive, dynamic team environment.

Skills

Communication

Coaching

Conflict resolution

Analytical skills

Data-driven decisions

Computer skills

Typing proficiency

Organization

Mentoring

Multi-priority management

Education

High school diploma or GED

Bachelor's degree preferred

Pharmacy Technician Certification or equivalent experience

Job description

Founded by industry pioneers, SlateRx provides simple and affordable pharmacy benefit programs to employer groups, unions, public sector groups, health systems, and other payers throughout the United States. As the industry’s only PBX, SlateRx is creating real value for plan sponsors on day one through purchasing scale and continued management via innovation and transparency. Our model is designed to improve an out-of-touch healthcare model to make pharmacy benefits simple and affordable for plan sponsors and members.

Job Overview:

The Clinical Coordinator Supervisor is responsible for supervising the coverage determination and appeals clinical coordinator team at SlateRx. This position will be responsible for the day-to-day activities of clinical operations, including efficiency, accuracy and timeliness of reviews.

Responsibilities:

As a Clinical Coordinator Supervisor, your key responsibilities will include:

Lead, coach, and mentor team members to achieve personal and professional growth.

Oversee day-to-day team operations, ensuring alignment with business objectives.

Lead the Clinical Coordinator team, inclusive of hiring, coaching, and evaluating staff.

Support and advise clinical coordinators with member, client, and software issues.

Handle escalated clinical issues, including escalated calls.

Research claim reject messaging associated with coverage determination and appeal requests.

Respond to routine inquiries and correspondence regarding coverage determinations and appeals with members, prescribers, and pharmacies as applicable.

Oversee the coverage determination and appeals process from start to finish to ensure queues are being handled efficiently and requests are completed timely.

Monitor and update daily productivity reports.

Develop Clinical Coordinator monthly schedules to ensure appropriate coverage for timely completion of coverage determinations and appeals, and answering of calls.

Report accomplishments, infractions, and overall productivity to upper management.

Train and update staff on changing procedures and PA automation system.

Conduct performance evaluations.

Promote and foster a professional, positive, dynamic team environment through exemplary leadership.

Mentor staff to improve skillset and career development.

Advise on employee promotions, transfers and dismissals.

Perform miscellaneous job-related duties as assigned.

Qualifications:

To excel in this role, you should possess the following qualifications:

Knowledge of pharmacy benefit management, CDAG operational processes, and regulatory requirements.

Strong analytical skills with experience in data-driven decision-making.

Excellent communication, coaching, and conflict-resolution skills.

Computer and typing proficiency.

Ability to adapt to a dynamic and fast-paced environment.

Possess excellent communication skills.

A good educator who is trustworthy and willing to share information and serve as a mentor.

Demonstrated ability to manage multiple priorities and deadlines.

A well-organized and self-directed individual who is able to work with minimal amount of supervision.

Capability to efficiently complete tasks in a demanding environment.

Education:

High school diploma or GED required; Bachelor’s degree strongly preferred.

License Requirement:

Current and valid Pharmacy Technician Certification, Licensure, or Registration; OR a minimum of 8 years’ experience with appropriate industry experience, preferably in the healthcare, insurance or PBM industry.