Managed Care Marketing Manager develops and implements marketing plans for a managed care organization. Promotes the organization's services to potential members and business partners. Being a Managed Care Marketing Manager identifies and targets new opportunities and sources of additional business and revenue. Requires a bachelor's degree. Additionally, Managed Care Marketing Manager typically reports to a head of a unit/department. The Managed Care Marketing Manager typically manages through subordinate managers and professionals in larger groups of moderate complexity. Provides input to strategic decisions that affect the functional area of responsibility. May give input into developing the budget. Capable of resolving escalated issues arising from operations and requiring coordination with other departments. To be a Managed Care Marketing Manager typically requires 3+ years of managerial experience. (Copyright 2024 Salary.com)
Central Health is Travis County's hospital district. We provide access to quality healthcare for under-resourced individuals within the county. Sendero Health Plans is the non-profit, community-based insurance plan of Central Health, Travis County's hospital district. Sendero offers On-Exchange individual coverage through the Marketplace, and partners with Central Health to operate special enrollment windows to bolster the coverage of the local safety net. Central Health governs and oversees the Medical Access Program for low-income Travis County residents, including formulary and Pharmacy Benefits Management (PBM) functions. Core to its mission to provide access to comprehensive, high-quality care for low-income residents of our community, Central Health also employs direct practice specialty providers.
The Managed Care Clinical Pharmacist will support managed care clinical pharmacy functions for both Sendero and Central Health programs and initiatives. The position provides highly specialized, integrated pharmacy services. The Pharmacist will provide drug utilization reviews based on established protocols for prior authorization and appeal requests, including provider outreach and engagement for educational purposes, as relevant. Forty percent of this providers time will be devoted to Sendero with the remaining sixty percent allocated to Central Health.
The Managed Care Clinical Pharmacist will assist with:Developing prior authorization review criteria for medications covered on pharmacy and medical benefits. Conducting oversight over prior authorization criteria and delegated utilization management functions performed by PBM and other vendors in the pharmacy and drug space (e.g. rebate aggregator, e.g. specialty drug utilization review vendor). Reviewing PBM formularies to identify opportunities for improvement and optimization. Creating, refining and maintaining policies and standard operating procedures for pharmacy operational processes. Coordinating with vendors and internal data analytics teams to create appropriate, clinically informed datasets, and to conduct analyses that identify new issues and opportunities for better clinical pharmacy management practices. Developing evidence-informed and data-based clinical initiatives that support the processes of formulary management, plan design, prior authorization, retrospective drug utilization review, and coordination between PBM and medical drug benefit functions. Providing educational communication and clinical consultation, with Enterprise colleagues, providers and members. Overseeing patient assistance programs and similar initiatives to ensure medication access among our community. Providing leadership and guidance across the Enterprise to ensure proactive responses to shifts in the regulatory and statutory environment. Other duties as assigned, to ensure quality of care for members while meeting expectations for prescription drug cost containment.
Doctor of Pharmacy Required
Minimum of 2 years of clinical pharmacy practice experience under a collaborative practice agreement, including providing drug therapy management in an ambulatory care clinical setting Required and2 years of applicable experience as a registered pharmacist with managed care job functions, such as for a health plan or Pharmacy Benefits Manager (PBM) Required and1 year of experience in PGY1 Managed Care Pharmacy residency Preferred or Experience with Medicare, Medicaid, Marketplace with a health plan or PBM Preferred and3 years’ experience as a registered pharmacist with managed care job functions, at a health plan or PBM working in utilization management, analytics, formulary management, and/or synthesis of clinical literature. Preferred and1 year of using EPIC Electronic Medical Record (EMR) experience Preferred
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