Manager Pharmacy Contact Center Priority Health

Facility: Priority Health - GRAND RAPIDS, MIDepartment: Ph-Customer Care Ctr AdminCategory: Health PlanClassification: Full-time with Benefits (A1)Provide leadership and direction to the cross-functional (clinical and non-clinical) Pharmacy Contact Center to ensure compliant operations are being maintained and applied across all products. Manage training and quality resources to ensure operational compliance and effectiveness. Effectively support Supervisors in coaching and mentoring direct reports.Responsible for:100 Seat Call CenterPharmacy related coverage, determinations and out of pocket expensesPrior Authorization ManagementHigh level determinations with providersForecasting and anticipated contact center volumeCreating customer experienceDeveloping strategies to manage the call volumesHiring and decision making with Talent AcquisitionBasic Qualifications:Education - or equivalent, Bachelor's degree in business or 5 years experience in health insurance or managed care environmentExperience - skills, knowledge, abilities typically gained through 5+ years of related experience in Pharmacy related setting with application of industry standards for claim adjudication.5 years of experience typically gained through dealing with employee relationship issues and providing appropriate guidance using human resource policies.3 years of experience typically gained through experience in Call Center operations.3 years of experience typically gained through experience in compliant oversight of Coverage Determination processes and training.3 years of experience typically gained through experience in compliant CMS regulations, including Part DPreferred Qualifications:PMP Certification3-5 year of leadership experienceSpectrum Health grants equal employment opportunity to all qualified persons without regard to race, color, national origin, sex, disability, age, religion, genetic information, marital status, height, weight, sexual orientation, veteran status, or any other legally protected category.