Aetna Manager, Clinical Pharmacy in Phoenix, Arizona
Req ID: 44632BR
Manager, Clinical Operations for Coverage Determination Duals/DSNP Program direct oversight of the clinical pharmacists team making the medical necessity/exception review decisions.
Manager, Clinical Operations for Coverage Determination Duals/DSNP Program direct oversight of the clinical pharmacists team making the medical necessity/exception review decisions. Ideal candidate will be a licensed pharmacist with 3 yrs management experience in a call center environment with 2-3 years experience with Medicare/Medicaid coverage determination reviews. 2-3 years knowledge implementing and adhering to CMS regulatory requirements with preferred experience in working with PBM to pull universe information for CDAG audits and facilitating and presenting business results.
In-depth knowledge and experience in managed care / managed pharmacy / competitive environment with a focus on Medicare 3 years clinical administrative experience in pharmacy related industry, or equivalent. 2 plus years of management experience
The highest level of education required for candidates in this position is a Bachelors degree.
LICENSES AND CERTIFICATIONSPharmacy/Licensed Pharmacist is required
Functional - Management/Management - Medicare/1-3 Years
Functional - Quality Management/Quality Management/1-3 Years
Functional - Medical Management/Medical Management - Pharmacy/1-3 Years
Technical - Desktop Tools/Microsoft Visio/1-3 Years/End User
Technical - Desktop Tools/Microsoft Word/1-3 Years/End User
Technical - Desktop Tools/Microsoft PowerPoint/1-3 Years/End User
Technical - Desktop Tools/Microsoft Outlook/1-3 Years/End User
Benefits Management/Interacting with Medical Professionals/ADVANCED
Leadership/Driving a Culture of Compliance/FOUNDATION
Leadership/Engaging and Developing People/ADVANCED
General Business/Maximizing Work Practices/FOUNDATION
Leadership/Collaborating for Results/FOUNDATION
ADDITIONAL JOB INFORMATION
Aetna is about more than just doing a job. This is our opportunity to re-shape healthcare for America and across the globe. We are developing solutions to improve the quality and affordability of healthcare. What we do will benefit generations to come.
We care about each other, our customers and our communities. We are inspired to make a difference, and we are committed to integrity and excellence.
Together we will empower people to live healthier lives.
Aetna is an equal opportunity & affirmative action employer. All qualified applicants will receive consideration for employment regardless of personal characteristics or status. We take affirmative action to recruit, select and develop women, people of color, veterans and individuals with disabilities.
We are a company built on excellence. We have a culture that values growth, achievement and diversity and a workplace where your voice can be heard.
Benefit eligibility may vary by position. Click here to review the benefits associated with this position.
Aetna takes our candidate's data privacy seriously. At no time will any Aetna recruiter or employee request any financial or personal information (Social Security Number, Credit card information for direct deposit, etc.) from you via e-mail. Any requests for information will be discussed prior and will be conducted through a secure website provided by the recruiter. Should you be asked for such information, please notify us immediately.
Job Function: Health Care