Region Manager Pharmacy Reimbursement-MTN
About Us
Inspired by faith. Driven by innovation. Powered by humankindness. CommonSpirit Health is building a healthier future for all through its integrated health services. As one of the nation’s largest nonprofit Catholic healthcare organizations, CommonSpirit Health delivers more than 20 million patient encounters annually through more than 2,300 clinics, care sites and 138 hospital-based locations, in addition to its home-based services and virtual care offerings.
Our Mission
As CommonSpirit Health, we make the healing presence of God known in our world by improving the health of the people we serve, especially those who are vulnerable, while we advance social justice for all. To learn more about a calling that defines and unites, please click here for more information about our mission, vision, and values.
The posted compensation range of $72.88 - $108.42 /hour is a reasonable estimate that extends from the lowest to the highest pay CommonSpirit in good faith believes it might pay for this particular job, based on the circumstances at the time of posting. CommonSpirit may ultimately pay more or less than the posted range as permitted by law.
As our Region Manager, Pharmacy Reimbursement, you will provide leadership and strategic decision support in developing, implementing, and monitoring strategies, policies, and programs to maximize the value and optimize the revenue of pharmacy resources.
Every day, you will play a critical role in leading transformative initiatives, acting as a key liaison with leadership, an advisory resource to teams system-wide, and a representative to external organizations. You will facilitate and resource cross-functional initiatives within a complex value chain, navigating a highly distributed team framework while balancing business goals and constraints. Key decisions will involve determining the strategic direction and operational policies for areas of responsibility, supported by appropriate input from key stakeholders. You will manage your internal team's resources to accomplish key performance indicators and strategically apply efforts to support organizational goals, collaborating across regions and with system teams.
To be successful in this role, you will possess extensive experience in pharmacy reimbursement, revenue cycle management, and strategic financial planning within a complex healthcare environment. You will demonstrate exceptional leadership, analytical, and strategic thinking skills, capable of identifying key opportunities to optimize pharmacy revenue and resource utilization. A deep understanding of the current and future healthcare landscape, critical indicators within the industry, and the ability to effectively manage and motivate a team, while fostering collaboration across diverse stakeholders, will be essential in driving transformative initiatives and maximizing the value of pharmacy resources.
- Develops, in conjunction with executive leaders and other key stakeholders, strategic initiatives to optimize pharmacy resource utilization, reduce financial risk for patients and CSH, and to optimize pharmacy financial performance and revenue integrity.
- Revenue Cycle: Serves on the Clinician Advisory Program working closely with teams in Appeals, Audits and Denials as well as Billing/Follow-Up/Prior Authorizations to optimize cash flow, reduce bad debt and write-offs and support patient co-pay assistance programs for high-cost drugs.
- Utilization Review: Serves as the Pharmacist Advisor liaison to inpatient and outpatient and specialty pharmacy teams to optimize appropriate utilization of high-risk, high-cost drugs, biosimilars and appropriate site-of-service.
- Manages a team of revenue cycle coordinators, billing denials specialists and others as assigned.
- Value Based Care: Provides consultation and analysis as needed to drive increased value and reduce overall total cost of care with a focus on pharmacy and medication-related programs and alignment with organizational priorities.
- External Partnerships: Fosters and maintains strong relationships with payers, vendors and other external stakeholders to promote timely identification and resolution of business issues and opportunities to achieve strategic targets.
Job Requirements
Required
- Bachelors Of Science from an accredited school of pharmacy, upon hire or
- Doctor Of Pharmacy from an accredited school of pharmacy, upon hire and
- Five recent years of health system leadership or management work experience in any pharmacy setting, upon hire and
- , upon hire
Preferred
- Masters Other in healthcare administration or business administration (MHA, MBA) and Completion of a pharmacy residency. , upon hire and
- Prior experience in Pharmacy Reimbursement or Revenue Cycle
Where You'll Work
Inspired by faith. Driven by innovation. Powered by humankindness. CommonSpirit Health is building a healthier future for all through its integrated health services. As one of the nation’s largest nonprofit Catholic healthcare organizations, CommonSpirit Health delivers more than 20 million patient encounters annually through more than 2,300 clinics, care sites and 137 hospital-based locations, in addition to its home-based services and virtual care offerings. CommonSpirit has more than 157,000 employees, 45,000 nurses and 25,000 physicians and advanced practice providers across 24 states and contributes more than $4.2 billion annually in charity care, community benefits and unreimbursed government programs. Together with our patients, physicians, partners, and communities, we are creating a more just, equitable, and innovative healthcare delivery system.
Depending on the position offered, CommonSpirit Health offers a generous benefit package, including but not limited to medical, prescription drug, dental, vision plans, life insurance, paid time off (full-time benefit eligible team members may receive a minimum of 14 paid time off days, including holidays annually), tuition reimbursement, retirement plan benefit(s) including, but not limited to, 401(k), 403(b), and other defined benefits offerings, as may be amended from time to time. For more information, please visit https://www.commonspirit.careers/benefits.
Unless directed by a Collective Bargaining Agreement, applications for this position will be considered on a rolling basis. CommonSpirit Health cannot anticipate the date by which a successful candidate may be identified.
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Equal Opportunity
CommonSpirit Health™ is an Equal Opportunity/Affirmative Action employer committed to a diverse and inclusive workforce. All qualified applicants will be considered for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, disability, marital status, parental status, ancestry, veteran status, genetic information, or any other characteristic protected by law. For more information about your EEO rights as an applicant, please click here.
CommonSpirit Health™ will not discharge or in any other manner discriminate against employees or applicants because they have inquired about, discussed, or disclosed their pay or the pay of another employee or applicant. However, employees who have access to the compensation information of other employees or applicants as a part of their essential job functions cannot disclose the pay of other employees or applicants to individuals who do not otherwise have access to compensation information, unless the disclosure is (a) in response to a formal complaint or charge, (b) in furtherance of an investigation, proceeding, hearing, or action, including an investigation conducted by the employer, or (c) consistent with the contractor’s legal duty to furnish information. 41 CFR 60-1.35(c). External hires must pass a post-offer, pre-employment background check/drug screen. Qualified applicants with an arrest and/or conviction will be considered for employment in a manner consistent with federal and state laws, as well as applicable local ordinances, ban the box laws, including but not limited to the San Francisco and Los Angeles Fair Chance Ordinances. If you need a reasonable accommodation for any part of the employment process, please contact us by telephone at (415) 438-5575 and let us know the nature of your request. We will only respond to messages left that involve a request for a reasonable accommodation in the application process. We will accommodate the needs of any qualified candidate who requests a reasonable accommodation under the Americans with Disabilities Act (ADA). CommonSpirit Health™ participates in E-Verify.