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Department

Job Summary

The Supervisor, Managed Care Pharmacy, performs supervisor/leadership functions over the Denver Health Medical Plan (DHMP) / Managed Care Pharmacy clinical pharmacist and administrative staff. Applies critical thinking, clinical knowledge, evidence-based policies, procedures, guidelines, and competence to collaborate with the team to promote excellence and quality outcomes. Adheres to all Federal, State, and local laws, regulations, applicable health plan pharmacy services, and plan design. The primary role of the Supervisor is to provide operational and collaborative leadership for the Managed Care Pharmacy Department, with specific attention to quality of care, timely access, supervision, and mentorship for the pharmacy clinical staff and call team. An essential goal of this role is to maximize efficiency and positively impact the care provided to our members. The incumbent will be adept at collaborating with different teams within the organization. In collaboration with the Director, leads the development of specific departmental goals, standards, and objectives that directly support the strategic plan and vision of the organization. Promotes department sustainability and cost containment efforts to achieve budget. Identifies and implements strategies to monitor variance reports to enhance productivity while maintaining high-quality service. Implements programs that promote high motivation among team members by coaching, counseling, and setting goals for direct reports.

Essential Functions:

• Supervises Pharmacist Clinical Specialist and Pharmacy Technician Call Center staff. Sets and communicates expectations to each employee and establishes job requirements and performance appraisal components. Regularly provides individual assessments to the Pharmacist Clinical Specialist and Pharmacy Technician Call Center staff to ensure timely feedback on performance expectations. (20%)
• Performs timeliness monitoring, prior authorization, and call center auditing. Results are shared with staff, and corrective action plans will be implemented if deemed necessary. Presents annual reports of this data to the Medical Management Committee (MMC) and Quality Management Committee (QMC). Maintains assigned measures and documentation associated with National Committee for Quality Assurance (NCQA) accreditation. (10%)
• Work with the clinical and operations staff of all vendors of pharmacy programs, including support to internal operational departments on implementing various programs. (10%)
• Completes Prior Authorization requests clinical reviews and keeps current knowledge of system issues, processes, etc. Provides this feedback to the PBM and works with them to resolve issues. (10%)
• Responsible for maintaining and updating Departmental Operating Procedures (DOPs) and Policy and Procedures (P&Ps) related to call center and prior authorization processes and oversight. (10%)
• Handles Call Center escalations and works to resolve issues related to grievance and appeals, enrollment, etc. Maintains processes and communication between Managed Care Call Center teams and other relevant departments for efficiencies (10%)
• Establishes and updates inbound and outbound call scripts. Creates standard workflows, identifies process gaps, and challenges self and others to develop and implement solutions. (10%)
• Evaluate and identify opportunities for improved management of drug benefits through clinical research and analytics that improve medical/pharmacy cost savings and provide clinical quality initiatives. (10%)
• Develop, implement, and manage pharmacy cost containment strategies, including high-risk, high-cost, and high-use medications, to determine the most appropriate medication use management strategy for identified medications. (10%)

Education:

• Bachelor's degree B.Pharm required

Work Experience:

• 1-3 years managerial/supervisory experience required or
• 1-3 years pharmacy, managed care, and/or pharmaceutical industry experience required

Licenses:

• PHA-Licensed Pharmacist - DORA - Department of Regulatory Agencies required

Knowledge, Skills and Abilities:

• Excellent verbal and written communication skills with the ability to communicate and collaborate effectively with all internal stakeholders.
• Strong interpersonal, consultation, organizational, tracking, and follow-up skills.
• Data review and interpretation skills are preferred to identify and resolve drug-related problems and trends.
• Ability to work as a team member.
• Strong organizational skills and attention to detail.
• Ability to instruct, direct, and evaluate employees- will be required to assume responsibility for daily PA operations.
• Ability to work independently and with little supervision.
• Prior experience and knowledge of process improvement practices
• Proficiency with Epic, preferred but not required
• Proficiency with MS Office required.

*This is a hybrid position with an in-office requirement of 3 days per week.

Shift

Work Type

Salary

Benefits

At Denver Health, we take care of the people who take care of our community. Our benefits are built to support your life, your family, and your future - with generous paid time off, fully paid parental leave, exceptional retirement contributions, comprehensive health coverage, and nationally recognized well-being programs. We invest in your growth through tuition assistance, career advancement pathways, and professional development - while also offering meaningful financial advantages through loan forgiveness eligibility and employer contributions. When you join Denver Health, you’re joining a mission-driven organization that invests in you.

Here is a small list of our benefit programs:

• Paid time off starting at 28 days per year, inclusive of vacation, personal/sick, and 7 Holidays

• 100% paid parental leave up to 6 weeks

• Immediate eligibility for retirement plans with employer contribution up to 9.5%

• Generous medical, dental, vision plans in addition to employer paid disability and life insurance.

• Comprehensive well-being programs including on-site employee fitness center located on Denver Health main campus and nationally recognized RESTORE Center

• Free RTD EcoPass (public transportation)

• Childcare discount programs & exclusive perks on large brands, travel, and more

• Tuition reimbursement & assistance

• Education, coaching, and professional development opportunities through the Workforce Development Center (WFDC) that support internal career growth and advancement pathways

• Professional clinical advancement program & shared governance

• Public Service Loan Forgiveness (PSLF) eligible employer+ free student loan coaching and assistance navigating the PSLF program

• National Health Service Corps (NHCS) and Colorado Health Service Corps (CHSC) eligible employer

About Denver Health

Denver Health is an integrated, high-quality academic health care system considered a model for the nation that includes a Level I Trauma Center, a 555-bed acute care medical center, Denver’s 911 emergency medical response system, 10 family health centers, 19 school-based health centers, Rocky Mountain Poison & Drug Safety, the Public Health Institute at Denver Health, Denver Health Medical Plan and Denver Health Foundation.

As Colorado’s primary, and essential, safety-net health care system, Denver Health is a mission-driven organization that has provided millions in uncompensated care for the uninsured each year.

Located near downtown Denver, Denver Health is just minutes away from many of the cultural and recreational activities Denver has to offer.

Denver Health is an equal opportunity employer (EOE). We value the unique ideas, talents and contributions reflective of the needs of our community. All job applicants for safety-sensitive positions must pass a pre-employment drug test, once a conditional offer of employment has been made. Applicants will be considered until the position is filled.

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About Denver Health

Take your career to the next level at Denver Health, where we offer a robust benefits package and endless opportunities for growth. Denver Health is a nationally-ranked, locally-trusted, premier healthcare institution located in the heart of Denver, Colorado.Twenty-five percent of all Denver residents, or approximately 150,000 individuals, receive their health care here. We are known as an integrated health care system that encompasses multidisciplinary academic specialties, a community health system, a level I adult trauma center, pediatric emergency and urgent care center home to Denver Public Health and many of the nation's leaders in medicine.Denver Health is an Equal Opportunity Employer At Denver Health we pride ourselves on our commitment to diversity. Equal opportunity is a fundamental principle of Denver Health. As an equal opportunity employer, Denver Health is committed to recruit, hire, promote and administer all human resource actions in a non-discriminatory manner. Denver Health is committed to providing equal opportunities in all business practices and to all persons regardless of age, race, color, national origin, genetic information, religion, sex, pregnancy, disab...ility, sexual orientation, gender identity, gender expression, marital status or veteran status (collectively “protected status”). Denver Health strives to maintain a work environment that is free from unlawful harassment and discrimination and will not tolerate any such conduct by employees or directed at employees within the scope of their employment. Read the full Human Resources Employee Principles and Practices policy.

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