Manager, Clinical Operations - Remote | WFH Job at Get It - Finance, Louisville, KY

QnpCbUtaTTZrMWFJc3JlbDlxN2IvSHFSUnc9PQ==
  • Get It - Finance
  • Louisville, KY

Job Description

We are looking for a passionate and dedicated Manager of Clinical Operations to lead and optimize clinical coding processes, benefit setups, and regulatory compliance. This role offers the opportunity to directly impact the efficiency and success of clinical operations, working closely with a talented team to ensure exceptional outcomes for both clients and members. You'll play a pivotal role in driving implementations, maintaining high standards of compliance, and ensuring the ongoing success of formulary and benefit updates.

Key Responsibilities:

Team Leadership:

Onboard, train, and manage a dynamic team, promoting both professional growth and operational excellence.
Mentor staff members and conduct performance evaluations to ensure a high-performing team.
Develop and maintain department policies and procedures to drive consistency and efficiency.
Clinical Operations Oversight:

Supervise coding updates in the claims adjudication platform, ensuring seamless clinical benefit setups and formulary updates.
Ensure regulatory compliance with ACA/preventive drug lists and maintain up-to-date knowledge on changes.
Assess the impact of Medispan drug database changes on formulary and benefit setups.
Testing and Quality Assurance:

Lead the pre-testing and post-testing of formulary and benefit changes to ensure accuracy and functionality.
Address escalations and troubleshoot operational issues related to clinical coding and benefit setups.
Implementation Leadership:

Serve as the Clinical Implementations Coding Lead for new client onboarding and benefit implementation projects.
Collaborate with cross-functional teams to ensure timely and seamless project delivery.
Regulatory and Accreditation Compliance:

Support activities related to URAC accreditation, ensuring clinical operations meet quality and compliance standards.
Stay current with regulatory changes to ensure alignment with industry standards.
Qualifications:

Bachelor's degree in Pharmacy (required), with an advanced degree (PharmD, MBA) preferred.
Active and unrestricted Pharmacist license.
5+ years of experience in clinical operations, coding management, or related roles.
3+ years of leadership experience preferred.
Strong background in pharmacy benefit management (PBM) preferred.
Expertise in clinical benefit setups, coding processes, and regulatory compliance.
Familiarity with clinical coding systems and platforms, with proficiency in Microsoft Office Suite.
Strong analytical, problem-solving, and project management skills.
Experience with Medispan or First Data Bank terminology is a plus.
Knowledge of ACA/preventive drug list maintenance and URAC accreditation requirements.
Collaborative team player with the ability to manage cross-functional relationships.
Willingness to travel up to 10%.
What We Offer:

An opportunity to drive meaningful change within the pharmacy benefits management industry while improving patient outcomes.
A supportive work culture that thrives on collaboration and employee success.
Competitive compensation, equity options, and a comprehensive benefits package (health, dental, vision, life insurance).
Additional Information:

Remote employees are expected to maintain a professional work environment free from distractions, ensuring optimal performance and collaboration.
Equal Opportunity Employer:
We are committed to creating an inclusive and diverse workplace. All qualified applicants will receive consideration for employment without regard to race, color, religion, gender, gender identity, sexual orientation, national origin, genetics, disability, age, or veteran status.
Employment Type: Full-Time
Salary: $ 115,000.00 Per Year

Job Tags

Full time,

Similar Jobs

Walmart Inc.

Manager, Business Development - Walmart Connect Job at Walmart Inc.

 ...do at Position Summary... What you'll do... About Walmart Connect Walmart Connect (WMC) is key to Walmarts growth...  ...consumers, and convert Walmart consumers to shoppers. The Manager, Business Development, also referred to as the Manager, Mergers... 

Washington University in St. Louis

Project Manager Research - Infectious Diseases | Washington University in St. Louis Job at Washington University in St. Louis

 ...community engagement. INSPIRE seeks an enthusiastic Project Manager to support its mission of advancing HIV implementation science...  ...: Bachelors degree or combination of education and/or experience may substitute for minimum education. Certifications: No... 

Kerry Group PLC

Sanitation & Quality Supervisor Job at Kerry Group PLC

Kerry is an equal opportunity employer. Employment decisions are made without regard to race, color, religion, national or ethnic origin, sex, sexual orientation, gender identity or expression, age disability, protected veteran status or other characteristics protected...

Bank of America Corporation

Network Security Engineer - Threat Engineer Job at Bank of America Corporation

 ...product evaluation requirements within and across domains The Security Transition and Integration Team is seeking a Threat Engineer to...  ...build requirements are met, while incurring zero impact to the network. The Individual must possess the ability to analyze and... 

TRUCKING PEOPLE

Class A CDL Regional Truck Driver 6 Months Experience Required Job at TRUCKING PEOPLE

 ...YEARS! We're not offering you just another truck driving job. LISTEN TO WHAT OUR...  ...have never been so content with any trucking company!"*** "They work with u with taking off for...  ...flexible career options, diverse routes, and top-notch safety features, your search ends...