Pharmacist Prior Authorization

Ann & Robert H. Lurie Childrens Hospital of Chicago provides superior pediatric care in a setting that offers the latest benefits and innovations in medical technology research and family-friendly design. As the largest pediatric provider in the region with a 140-year legacy of excellence kids and their families are at the center of all we do. Ann & Robert H. Lurie Childrens Hospital of Chicago is ranked in all 10 specialties by the U.S. News & World Report.

General Summary of Position Responsibility:

The Clinical Prior Authorization Department (CPAD) Manager is responsible for developing and maintaining a program to facilitate prior authorizations for the medical center in collaboration with the Financial Clearance Department and Ambulatory Division Leadership.

Manages the professional and operational activities of the department assuring high quality accurate efficient and complete authorization services. Coordinates the day-to-day activities of the department. Responsible for the efficient use of both physical and human resources. Facilitates the operation and growth of the CPAD and its staff members through encouragement education and mentorship.

Essential Job Functions:

Leadership Competencies:

Personal Leadership

• Acts with integrity
• Builds trusting relationships
• Approachable; seeks to be helpful
• Leads from strengths and strives to improve weaknesses
• Thinks strategically and communicates with others frequently
• Leads with flexibility and adaptability
• Models and holds self accountable for Lurie Childrens values and core

competencies (service innovation and teamwork)

• Leads with courage and confidence
• Seeks to continuously learn and improve by soliciting and acting on feedback
• Takes initiative to build knowledge by leveraging resources and

asking questions

Organizational Awareness and Alignment

• Shares subject matter expertise
• Frequent and clear communication in all directions to ensure alignment
• Identifies and collaborates with stakeholders to achieve results; drives to

operational excellence

• Is a good financial steward
• Is an advocate for self and team members
• Understands and models the Lurie Childrens culture by living the service

principles and values

• Thinks strategically and shares knowledge; sets and communicates
• while cascading Lurie Childrens strategic goals
• Understands organizational structure and navigates successfully
• Builds and leverages relationships with stakeholders inside Lurie

Childrens and beyond own team

Leading Through Change

• Leads change confidently and with competence by owning the message

and walking the talk

• Is strategic and helps others by communicating often including providing

rationale and vision for changes

• Asks questions and shares assumptions to support and lead others through
• Is a self-directed learner; gathers knowledge about healthcare climate and

cascades to others

• Communicates and facilitates each initiative to adapt to a rapidly changing

healthcare climate

• Continuously evaluates and improves upon the change to speed up decision

making and ensure the optimal solution is reached

Influencing and Leading Others

• Provides clarity by defining roles responsibilities and priorities
• Holds self and others accountable
• Helps team members grow and develop by finding opportunities and giving

frequent feedback

• Identifies gaps in teams skills
• Shares or develops tools and resources to fill gaps
• Leads with compassion and authenticity
• Increases span of influence with stakeholders beyond direct reports
• Actively listens and seeks to understand
• Breaks down complex problems and helps to set goals and expectations
• Engages and empowers others; has a mindset of developing others for

their own growth and the organizations success

• Champion of Lurie Childrens mission and strategic goals by modeling the

service principles

• Proactively addresses performance issues and conflict

Area Specific Job Accountabilities:

• Collaborate with Division Leaders Financial Clearance Department clinical staff and other appropriate individuals to review prior authorization processes.
• Manages the professional and operational activities of the department. Assures high quality accurate efficient and complete authorization services.
• Supervises coordinates and organizes the day-to-day operational activities and has authority and accountability for the management of CPAD employees.
• Organizes and prioritizes the authorization workload and collaborates with the CPAD nurses and pharmacy technicians as well as pharmacy management team to effectively manage daily operations.
• Routinely evaluates CPAD services and identifies develops and implements ways to improve productivity and efficiency.
• Ensures adequate staffing to perform the daily departmental functions. Oversees scheduling of pharmacists and technicians. Manges staffing in case of unplanned absences and redirects staff when necessary.
• Leads and/or participates in the CPAD employee recruitment process.
• Coordinates staff development and training in drug information to maintain drug knowledge and disease state understanding for application to prior authorization reviews. Recommend therapeutic substitutions to providers based on insurance formulary alternatives or patient specific factors.
• Measures the performance of CPAD staff and when appropriate oversees employees corrective action plans in disciplinary situations according to the organizations policies and in coordination with the Human Resources.
• Oversees timekeeping and productivity for staff and addresses variances to expectations according to system and departmental policies.
• Conducts annual performance appraisals for direct reports.
• Ensures that department policies and procedures are properly administered. Develops new policies and procedures; and routinely evaluates and updates existing policies and procedures as needed.
• Serves on interdisciplinary committees as a pharmacy and CPAD liaison and subject matter expert on prior authorizations procedures and activities.
• Attends and participates in internal or external user groups and professional organizations to enhance professional knowledge.
• Collaborate with Informatics and others to maintain and improve the appropriate documentation of prior authorization information in the Electronic Medical Record.
• Collaborate with Billing Department by investigating and assisting with any denied claims for high cost drugs.
• Perform financial investigations related to high cost drugs. Develop cost savings and revenue enhancement strategies.
• Performs job functions adhering to service principles with customer service focus of innovation service excellence and teamwork to provide the highest quality care and service to our patients families co-workers and others. Creates an environment of high morale and motivated professionals. Works cooperatively with other staff members to enhance the team concept.

Knowledge Skills and Abilities:

• Active Illinois Pharmacist License.
• Minimum 5 years of experience as a practicing pharmacist required.
• Minimum 1 year of experience with specialty medications or direct prior authorization experience required.
• Pharmacy Benefits Management experience preferred.
• Experience in commercial and/or Medicaid prescription drug plans programs or formularies preferred.
• Continually evaluates responsibilities and processes with recommendations for improvement. Advances knowledge base through self-directed learning to maintain competency.
• Demonstrates teamwork by assisting and encouraging the team to participate in identification of problems formulation of plans and initiation of corrective measures and follows-up to make certain suitable action is taken.
• Is able to mentor team at any level.
• Promotes positive work environment as evidenced by quality service provided and positive team attitudes.
• Excellent communication skills. Demonstrates critical thinking skills and interpersonal skills. Has essential team building skills.
• Strong analytical and problem-solving skills

Education

Pay Range

At Lurie Childrens we are committed to competitive and fair compensation aligned with market rates and internal equity reflecting individual contributions experience and expertise. The pay range for this job indicates minimum and maximum targets for the position. Ranges are regularly reviewed to stay aligned with market conditions.In addition to base salary Lurie Childrens offer a comprehensive rewards package that may include differentials for some hourly employees leadership incentivesfor select roles health and retirement benefits and wellbeing programs. For more details on other compensation consult your recruiter or click the followinglink to learn more about our benefits.

Benefit Statement

For full time and part time employees who work 20 or more hours per week we offer a generous benefits package that includes:

Medical dental and vision insurance

Employer paid group term life and disability

Employer contribution toward Health Savings Account

Flexible Spending Accounts

Paid Time Off (PTO) Paid Holidays and Paid Parental Leave

403(b) with a 5% employer match

Various voluntary benefits:

• Supplemental Life AD&D and Disability

• Critical Illness Accident and Hospital Indemnity coverage

• Tuition assistance

• Student loan servicing and support

• Adoption benefits

• Backup Childcare and Eldercare

• Employee Assistance Program and other specialized behavioral health services and resources for employees and family members

• Discount on services at Lurie Childrens facilities

• Discount purchasing program

Theres a Place for You with Us

At Lurie Childrens we embrace and celebrate diversity and equity in a serious way. We are committed to building a team with a variety of backgrounds skills and viewpoints recognizing that diverse identities strengthen our workplace and the care we can provide to the Chicago community and beyond. We treat everyone fairly appreciate differences and make meaningful connections that foster belonging and allyship. This is a place where you can be your best so we can give our best to the patients and families who trust us with their care.

Lurie Childrens and its affiliatesare equal employment opportunity employers. We value diversity and are committed to creating an inclusive environment for all employees. All qualified applicants will receive consideration for employment without regard to race color sex sexual orientation gender identity or expression religion national origin ancestry age disability marital status pregnancy protected veteran status order of protection status protected genetic information or any other characteristic protected by law.

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