Region Manager Pharmacy Reimbursement - CA
The posted compensation range of $68.76 - $99.70 /hour is a reasonable estimate that extends from the lowest to the highest pay CommonSpirit in good faith believes it might pay for this particular job, based on the circumstances at the time of posting. CommonSpirit may ultimately pay more or less than the posted range as permitted by law.
- US-CA-RANCHO CORDOVA | US-CA-Redding | US-CA-BAKERSFIELD | US-CA-GLENDALE |
CommonSpirit Health was formed by the alignment of Catholic Health Initiatives (CHI) and Dignity Health. With more than 700 care sites across the U.S. from clinics and hospitals to home-based care and virtual care services CommonSpirit is accessible to nearly one out of every four U.S. residents. Our world needs compassion like never before. Our communities need caring and our families need protection. With our combined resources CommonSpirit is committed to building healthy communities advocating for those who are poor and vulnerable and innovating how and where healing can happen both inside our hospitals and out in the community.
While you're busy impacting the healthcare industry, we'll take care of you with benefits that include:
Medical/Dental/Vision, FSA, Dependent Care Spending Account, Life Insurance, Short and Long-term Disability, 401k match, Paid Time Off, Wellness Program, Tuition Reimbursement, Accidental Insurance, Critical Illness Insurance, Identity Theft Protection, Employee Assistance Program, and more!
Responsibilities
Thi This is a remote position and incumbents must reside in California.
Job Summary
This job is responsible for providing leadership and strategic decision support in the development, implementation and monitoring of strategies, policies and programs to maximize the value of pharmacy resources (product, service, provider) utilization, contracts and vendor performance and optimization of pharmacy revenue. An incumbent plays a critical role in leading transformative initiatives, acts as a key liaison with leadership, an advisory resource to teams systems-wide and as a representative to external organizations. This position will be a manager and have direct reports.
Work requires cross-functional facilitation and resourcing of initiatives within a complex value chain while working within a highly distributed team framework and balancing CommonSpirit Health’s business goals and constraints. Key decisions, supported with appropriate input from key stakeholders, include determining the strategic direction and operational policies for areas of responsibility and others within defined scope. The incumbent will manage the resources of their internal team to accomplish key performance indicators and strategic application of work efforts to support organizational goals. They will also collaborate across regions and work with the system team to accomplish key goals.
An incumbent works collaboratively with diverse teams across the full value chain, including System Pharmacy Operations, Specialty Pharmacy, Patient Care Services, Corporate Services, Business Strategy and Pharmacy Informatics to ensure transparency and coordination to achieve consummate performance and outcomes.
Successful performance requires the ability to effectively apply expertise and working knowledge of the current and future healthcare landscape and critical indicators within the healthcare industry to identify key strategies and opportunities to optimize the ability of CSH to meet the needs of the patient population served.
Key Job Responsibilities
- Develops, in conjunction with executive leaders and other key stakeholders, strategic initiatives to optimize pharmacy resource utilization, reduce financial risk for patients and CSH, and to optimize pharmacy financial performance and revenue integrity.
- Revenue Cycle: Serves on the Clinician Advisory Program working closely with teams in Appeals, Audits and Denials as well as Billing/Follow-Up/Prior Authorizations to optimize cash flow, reduce bad debt and write-offs and support patient co-pay assistance programs for high-cost drugs.
- Utilization Review: Serves as the Pharmacist Advisor liaison to inpatient and outpatient and specialty pharmacy teams to optimize appropriate utilization of high-risk, high-cost drugs, biosimilars and appropriate site-of-service.
- Manages a team of revenue cycle coordinators, billing denials specialists and others as assigned.
- Value Based Care: Provides consultation and analysis as needed to drive increased value and reduce overall total cost of care with a focus on pharmacy and medication-related programs and alignment with organizational priorities.
- External Partnerships: Fosters and maintains strong relationships with payers, vendors and other external stakeholders to promote timely identification and resolution of business issues and opportunities to achieve strategic targets.
#LI-CSH
Qualifications
Education and Experience
- B.S. or Doctor of Pharmacy degree from an accredited school of pharmacy
- Five recent years of progressively responsible health system management work experience in any pharmacy setting
- ASHP Certificate in Pharmacy Revenue Cycle is preferred
- Active California State Pharmacist License in good standing
- Knowledge of the principles, practices, standards, techniques, requirements and tools/equipment applicable to the pharmaceutical services field, including business development distribution, protocol design, monitoring/intervention and medication management
- Knowledge of the content, intent and application of federal and state regulatory requirements pertaining to matters within designated scope of responsibility
- Knowledge of the principles, practices and methodologies pertaining to healthcare delivery systems
- Knowledge of strategic planning, qualitative/quantitative evaluation and analysis, advanced quality/performance improvement program development/implementation and performance management
Unless directed by a Collective Bargaining Agreement, applications for this position will be considered on a rolling basis. CommonSpirit Health cannot anticipate the date by which a successful candidate may be identified.
Apply
Depending on the position offered, CommonSpirit Health offers a generous benefit package, including but not limited to medical, prescription drug, dental, vision plans, life insurance, paid time off (full-time benefit eligible employees may receive a minimum of 14 paid time off days, including holidays annually), tuition reimbursement, retirement plan benefit(s) including, but not limited to, 401(k), 403(b), and other defined benefits offerings, as may be amended from time to time. For more information, please visit https://www.commonspirit.careers/benefits.
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Equal Opportunity
CommonSpirit Health™ is an Equal Opportunity/Affirmative Action employer committed to a diverse and inclusive workforce. All qualified applicants will be considered for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, disability, marital status, parental status, ancestry, veteran status, genetic information, or any other characteristic protected by law. For more information about your EEO rights as an applicant, please click here [PDF].
CommonSpirit Health™ will not discharge or in any other manner discriminate against employees or applicants because they have inquired about, discussed, or disclosed their pay or the pay of another employee or applicant. However, employees who have access to the compensation information of other employees or applicants as a part of their essential job functions cannot disclose the pay of other employees or applicants to individuals who do not otherwise have access to compensation information, unless the disclosure is (a) in response to a formal complaint or charge, (b) in furtherance of an investigation, proceeding, hearing, or action, including an investigation conducted by the employer, or (c) consistent with the contractor’s legal duty to furnish information. 41 CFR 60-1.35(c). External hires must pass a post-offer, pre-employment background check/drug screen. Qualified applicants with an arrest and/or conviction will be considered for employment in a manner consistent with federal and state laws, as well as applicable local ordinances, ban the box laws, including but not limited to the San Francisco and Los Angeles Fair Chance Ordinances. If you need a reasonable accommodation for any part of the employment process, please contact us by telephone at (415) 438-5575 and let us know the nature of your request. We will only respond to messages left that involve a request for a reasonable accommodation in the application process. We will accommodate the needs of any qualified candidate who requests a reasonable accommodation under the Americans with Disabilities Act (ADA). CommonSpirit Health™ participates in E-Verify.