Job Summary
A health insurance company needs applicants for an opening for a Virtual Healthcare Coverage Review Operations Manager.
Candidates will be responsible for the following:
- Developing and implementing improved operational processes and procedures
- Hiring, training, coaching and evaluating the performance of the respective professional and support staff
- Maintaining a proper workflow while meeting regulatory guidelines for timeliness
Must meet the following requirements for consideration:
- Bachelor’s degree or equivalent work-related experience
- 5 years’ experience in managed care pharmacy and/or retail pharmacy
- Proficient in Microsoft Office (Outlook, Work, Excel and Powerpoint)
- Knowledge of Medical terminology
- Understanding of health care, PBM, and pharmaceutical industries
- Solid understanding of regulatory guidelines (FDA, NCQA, EQRO, CMS)
- Knowledge of pharmacy coverage review processes and guidelines
