Manager, Pharmacy Services

<strong>At Emergent Holdings, we&rsquo;re creating an innovative environment where our employees belong authentically, contribute meaningfully, and thrive intentionally &mdash; both personally and professionally.</strong>

Southfield, MI*

Emergent Holdings

<p class="p1"><strong>Emergent Holdings is driven by a singular goal &mdash; improving the health and safety of our customers and our communities. How do we do that? We create innovative insurance products, technology solutions, and services to support our key stakeholders &mdash; individuals, employers, providers, and strategic partners &mdash; improving the health and safety of the people and places we serve.</strong></p>

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Competitive Compensation and Benefits Package

Overview: <p>The Manager, Pharmacy CDAG (Coverage Determinations, Grievances and Appeals) is responsible for all aspects of pharmacy help desks, including coverage determinations, appeals and grievances. The Manager, Pharmacy CDAG will also work closely with leadership in non-pharmacy areas of compliance and oversight to ensure ongoing compliance with all CMS guidance and regulations.</p>
Responsibilities: <ul> <li>Manages, supervises, sets performance goals/objectives, monitors performance, evaluates, and mentors clinical and non-clinical staff</li> <li>Develop and implement rigorous internal review and mock audit protocols in line with CMS and other external or internal compliance expectations.</li> <li>Create, manage and maintain documentation, including but not limited to departmental policies and procedures, to support regulatory oversight.</li> <li>Prepares, reviews, and conducts presentations or educational programs to various audiences, including customers, agents, and internal marketing departments.</li> <li>Support review and resolution of clinical and compliance grievances and appeals.&nbsp;</li> <li>Support clinical initiatives related to STAR measures.</li> <li>Adhere to Pharmacy Policies and Procedures</li> </ul> <p><strong>DIRECTION EXERCISED:</strong></p> <p>Directly supervises exempt staff in accordance with company policies and applicable Federal and State Laws.&nbsp; Responsibilities include, but are not limited to, effectively interviewing, hiring, terminating, and training employees; planning, assigning, and directing work; appraising performance; rewarding and counseling employees; addressing complaints and resolving problems; supporting and encouraging the engagement process.</p>
Requirements: <p><strong>EDUCATION:</strong></p> <p>Bachelor&rsquo;s degree in Business Administration, Health Care Administration, Marketing, or a related field.&nbsp; &nbsp;Master&rsquo;s degree in a related field is preferred.&nbsp; Relevant combination of education and experience may be considered in lieu of degree.&nbsp; Valid Michigan Accident and Health Insurance license is required for managers whose primary emphasis is sales.&nbsp; Valid and unrestricted driver&rsquo;s license is required.&nbsp; &nbsp;&nbsp;Continuous learning, as defined by the Company&rsquo;s learning philosophy, is required.&nbsp; Certification or progress toward certification is highly preferred and encouraged.</p> <p><strong>EXPERIENCE:</strong></p> <p>Seven years experience of progressive responsibility in a business environment with demonstrated technical knowledge that provides the necessary knowledge, skills, and abilities required.&nbsp; Three years supervisory or lead experience in business required.&nbsp; Bilingual skills preferred.</p> <p><strong>SKILLS/KNOWLEDGE/ABILITIES (SKA) REQUIRED:</strong></p> <ul> <li>Thorough knowledge of applicable CMS regulations related Medicare pharmacy benefits.</li> <li>Decision making, organizational, and problem-solving skills.</li> <li>Excellent analytical skills.</li> <li>Proficient in current industry standard PC applications and systems (e.g., Word, Excel and PowerPoint).</li> <li>Must demonstrate leadership ability and team building skills to effectively supervise professional and non-professional staff and interact with all levels of management.</li> </ul> <ul> <li>Ability to work with and empower others on a collaborative basis to ensure success of unit team.</li> </ul> <ul> <li>Ability to effectively exchange information, in verbal or written form, by sharing ideas, reporting facts and other information, responding to questions and employing active listening techniques.</li> <li>Ability to effectively present budgetary and/or cost information and respond to questions as appropriate.</li> </ul> <p>Ability to establish workflows, manages multiple projects, and meets necessary deadlines.</p> <div id="gtx-trans" style="position: absolute; left: -23px; top: 26px;">&nbsp;</div>