Manager, Utilization Management - Commercial

4+ years of prior authorization experience at a PBM or health plan

3+ years of leadership experience preferred

Experience with multiple lines of business including Commercial and Medicare Part D preferred

All employees are responsible for adherence to the Capital Rx Code of Conduct including the reporting of non-compliance.

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Lead and nurture a dynamic team of clinical pharmacists and technicians dedicated to the prior authorization and appeals process.

Create and uphold robust policies and procedures for utilization management review.

Utilize available data to optimize prior authorization staffing and streamline workflow.

Respond to requests for information (RFI) and requests for proposal (RFP) regarding prior authorization processes.

Generate and deliver comprehensive reports on prior authorization metrics to both internal and external stakeholders.

Manage contracts with external Independent Review Organizations and clinical resource vendors