Texas Licensed Utilization Management Manager

Job Summary

A company is looking for a Manager, Utilization Management Oversight.

Key Responsibilities

• Develop and maintain prior authorization policies and procedures compliant with regulations
• Provide oversight on utilization management turnaround times and ensure compliance with accrediting bodies
• Represent the prior authorization team during audits from regulatory bodies

Required Qualifications

• Active, unrestricted pharmacist license
• 1+ years of prior authorization review or appeals experience
• 2+ years of compliance or regulatory experience at a PBM or health plan
• Extensive knowledge of Medicare, ERISA, and state-regulated prior authorization requirements
• Intermediate to advanced Microsoft Excel skills