Anthem Staff VP Pharmacy Operations (Prior Authorization)-132462 in Lynnwood, Washington

Responsible for leading and directing the pharmacy benefit management operations prior authorization group, through a staff of Pharmacists and non-Pharmacists. Ensure the operational areas meet state and CMS requirements in an efficient manner through process improvement, improved productivity, improved turnaround time, reduced costs and increased quality results. Functional responsibility includes prior authorization operations and call center.


· Develops, implements, and manages a strategic plan for PA operations; resolves problems and provides guidance to team. · Management of functional SG&A budget and effective management of capital and human resources. · Identifies and communicates quality and process improvement opportunities and leads process improvement changes; · develops and execute appropriate department work flows · Develops, implements and monitors processes, policies and procedures to optimize work processes, maximize efficiencies and ensure compliance with corporate, state, regulatory, NCQA and URAC requirements. · Ensure benefit configurations meet state and CMS requirements; · Establishes quality and productivity standards for PA operations positions and programs. · Responsible for the prior authorization system administration. · Responsible for disaster planning and business continuity recovery plan. · Responsible for Vendor Management functions of PA systems and PA vendors (as applicable) · Responsible for driving new strategies to achieve improved e-PA targets · Creates a culture of compliance and rigorous oversight · Develops and mentors staff to create depth of resources in alignment with departmental needs · Other Duties as Assigned.

/Education Required: / Bachelors Degree in business related field Preferred: BS Pharm/Pharm D Advanced business degree - MS or MBA

Years and Type of Experience Required:

  • Minimum of 12 years experience in pharmacy department management within managed care or Pharmacy Benefit Management Operations or equivalent Medicaid and Medicare Part D experience
  • At least 7 years of leadership/management experience of clinical and non-clinical staff
  • Strong working knowledge of pharmacy benefit management and managed care Total Quality Management, Six Sigma or similar process improvement experience. /Preferred:/Minimum of 1 year managed care experience and knowledge of Managed Pharmacy Environment, Retail pharmacy, HMO or PBM experience

/Certifications or Licensures/ Process Improvement, Total Quality Management, Six Sigma or equivalent / / /Preferred:Technical Competencies:/ /Required:/Proficient with Microsoft Office Working knowledge of pharmacy claims processing Experience with web based prior authorization applications Pharmacist with PBM experience Perform basic data queries and analysis with applications such as Microsoft Access or Excel


Job Customer Service

Equal Employment Opportunity Statement Anthem, Inc. will recruit, hire, train and promote persons in all job titles without regard to age, color, disability, gender (including gender identity), marital status, national origin, race, religion, sex, sexual orientation, veteran status, or other status protected by applicable law. In addition, all personnel actions such as compensation, promotion, demotion, benefits, transfers, staff reductions, terminations, reinstatement and rehire, company-sponsored training, education and tuition assistance, and social and recreational programs will be administered in accordance with the principles of equal employment opportunity.

Title: Staff VP Pharmacy Operations (Prior Authorization)-132462

Location: washington-Lynnwood

Other Locations: OH-Mason, VA-Virginia Beach, MO-St. Louis

Requisition ID: 132462