Pharmacy Medication Authorization and Access Manager

Beth Israel Lahey Health; Boston (MA); On-site; USD 95,000 - 118,000; Full time

Job summary

Beth Israel Lahey Health is seeking a staffing and operations leader to manage the Medication Authorization and Access team. You will oversee prior authorizations, financial clearance, and patient assistance programs while supervising staff and improving processes.

Collaboration with Pharmacy Corp leadership and ambulatory services is essential to ensure timely medication access. The role requires an associates degree (bachelor's preferred) and a licensed pharmacy technician credential, with 3–5

Qualifications

• Associates degree required; Bachelor's preferred.
• Licensed Certified Pharmacy Technician required.
• 3–5 years related work experience and 1–3 years supervisory experience.
• Strong understanding of insurance/adjudication; ability to present data.

Responsibilities

• Oversees prior Authorization functions, financial clearance, and patient assistance programs.
• Leads development, implementation, and quality of staff processes and procedures.
• Supervises staff performance and coordinates training and schedules.
• Collaborates with Pharmacy Corp leadership and Ambulatory Pharmacy Services teams.
• Ensures timely delivery of medications and maintains provider relationships.

Skills

Licensed Pharmacy Technician

Pharmacy operations experience

Supervisory experience

Insurance adjudication knowledge

Microsoft Office proficiency

Education

Associates degree

Bachelor's degree

Tools

Microsoft Office Suite

Job description

When you join the growing BILH team, you're not just taking a job, you're making a difference in people's lives.

Responsible for managing all aspects of the Medication Authorization and Access team which includes prior authorizations/financial clearance, patient assistance program, and denial management. The manager will lead, support, and manage all the staff and functions of the department to ensure patients can access the drugs they need.

Job Description:

• Oversees the functions related to prior Authorization for prescriptions, financial clearance for hospital based infusion/injection services and our Patient Assistance Programs.
• Responsible for the development, implementation, administration, and quality of the groups systems, policies and procedures.
• Assumes direct supervision of the staff and their performance.
• Coordinates, communicates, maintains schedules, trains, and monitors the development and evaluation of their staff. Works collaboratively as part of the Pharmacy Corp leadership team and in particular the Ambulatory Pharmacy Services team to achieve our goals and purpose.
• Ensures processes consistently communicate with staff, patients, and providers to ensure proper and timely delivery of medications.
• Ensures strong working relationships with clinics and physicians to ensure we are providing the level of service to support their patients.
• Works collaboratively with our Data analytics and financial teams to ensure that infusions and injections are being paid correctly.
• Participates as a member of the Quality Management Committee to provide quality management oversight to the pharmacy operations and client satisfaction.

Required Qualifications:

1. Associates degree required. Bachelor's degree preferred.
2. License Certified Pharmacy Technician required.
3. 3-5 years related work experience required and 1-3 years supervisory/management experience required.
4. Strong understanding of insurance and adjudication processes with a robust understanding of prior authorizations through pharmacy and medical benefits. Demonstrated ability to produce quantitative and qualitative analysis in a presentation format. Advanced skills with Microsoft applications which may include Outlook, Word, Excel, PowerPoint or Access and other web-based applications. May produce complex documents, perform analysis and maintain databases.

Pay Range:

$94,993.60 USD - $117,998.40 USD

The pay range listed for this position is the annual base salary range the organization reasonably and in good faith expects to pay for this position at this time. Actual compensation is determined based on several factors, that may include seniority, education, training, relevant experience, relevant certifications, geography of work location, job responsibilities, or other applicable factors permissible by law.

As a health care organization, we have a responsibility to do everything in our power to care for and protect our patients, our colleagues and our communities. Beth Israel Lahey Health requires that all staff be vaccinated against influenza (flu) as a condition of employment.

More than 35,000 people working together. Nurses, doctors, technicians, therapists, researchers, teachers and more, making a difference in patients' lives. Your skill and compassion can make us even stronger.

Equal Opportunity Employer/Veterans/Disabled