Overview of the Position

The Clinical Pharmacy Manager serves as the clinical and operational leader of the Medication Access Department. This pharmacist is responsible for overseeing medication access operations, staffing, workflow optimization, quality initiatives, prior authorization support, patient assistance program services, and clinical appeals activities throughout the organization.

This individual is accountable for departmental performance, staff development, process improvement, and ensuring patients receive timely and affordable access to prescribed therapies. The pharmacist will maintain expertise in medication access programs, payer requirements, manufacturer assistance programs, and departmental workflows while serving as the clinical resource for complex medication access issues.

The Clinical Pharmacy Manager must maintain competency in all departmental functions and provide direct operational coverage for Medication Access Technician positions as needed to ensure continuity of services. The Director of Clinical Pharmacy will provide oversight of this position.

Qualifications

Required

• PharmD degree from an accredited College of Pharmacy
• Current, valid pharmacist license in the state of primary practice site
• Complex and innovative problem-solving, analytical, critical, and strategic thinking skills
• Strong knowledge of pharmacy benefit management, insurance processes, prior authorization requirements, and medication assistance programs
• Experience with electronic medical records and pharmacy-related software systems
• Maintains at least the minimum Continuing Education requirements for keeping state licensure

Preferred

• At least one year of post-graduate residency training OR at least 2 years of experience in ambulatory care pharmacy, managed care pharmacy, specialty pharmacy, medication access, or related practice area
• Previous supervisory or leadership experience
• Board Certification in an applicable area of pharmacy practice

Essential job Functions

ADMINISTRATIVE/BUSINESS RESPONSIBILITIES

• Oversees daily operations of the Medication Access Department
• Develops and monitors workflows, quality measures, and key performance indicators
• Maintains current knowledge of payer requirements, formularies, manufacturer assistance programs, and medication access resources
• Develops policies, procedures, and training materials
• Leads process improvement initiatives

STAFFING AND SUPERVISORY RESPONSIBILITIES

• Provides oversight and support for Medication Access staff
• Assists with onboarding, training, competency assessment and development
• Ensures adequate staffing coverage
• Monitors productivity and quality metrics

MEDICATION ACCESS RESPONSIBILITIES

• Maintains expertise in all medication access programs and workflows
• Oversees prior authorizations and patient assistance services
• Serves as departmental escalation resource
• Provides technician coverage as needed

CLINICAL APPEALS RESPONSIBILITIES

• Authors and submits complex clinical appeals
• Develops evidence-based appeal letters
• Collaborates with providers to obtain supporting documentation
• Tracks outcomes and trends

Skills

• Clinical writing
• Leadership
• Problem solving
• Workflow management
• Effective communication
• Time management

Expectations

• Behaves in accordance with company culture and policy
• Maintains confidentiality
• Continually seeks to learn and improve
• Supports departmental and organizational initiatives
• Performs other duties as assigned

Performance Evaluation Areas

• Medication Access Outcomes
• Prior Authorization Approval Rate
• Appeal Approval Rate
• Turnaround Time
• Productivity
• Leadership
• Staff Development
• Quality of Work
• Job Knowledge
• Communication Skills
• Dependability

Key Performance Indicators

• Prior authorization turnaround time
• Prior authorization approval rate
• Appeal approval rate
• Patient assistance enrollment and renewal completion rate
• Estimated patient cost savings
• Staff retention rate
• Documentation compliance rate
• Workflow improvement projects completed

Physical Requirements

• Hearing: Adequate to perform job duties in person and over the telephone.
• Speaking: Must be able to communicate clearly to patients in person and over the telephone.
• Vision: Visual acuity adequately to perform job duties, including reading information from printed sources and computer screens.
• Other: Requires occasional lifting and carrying items weighing up to 10 pounds unassisted in normal daily activities and up to 30 lbs. for other required work activities. Additionally, requires frequent bending, reaching, and repetitive hand movements (especially if keyboarding and writing), standing, walking, squatting, and sitting, with some lifting, pushing, and pulling exerted regularly throughout a regular work shift.