Pharmacist Manager - Prior Authorizations & Benefit Investigation

  • 3200 Lake Emma Rd, Lake Mary, FL 32746, USA
  • Full-time

Company Description

Kroger Specialty Pharmacy is a Clinical Pharmacy. Our programs optimize patient outcomes by blending a high-touch, caring patient experience with specialized clinical knowledge, personalized care programs, and administrative expertise.

Job Description

Position Summary

Perform functions to plan for and manage the Patient Access function, involving initial intake, insurance benefits investigation, and authorization requirements, cultivating an environment of outstanding customer service, as the voice of the company in all interactions with referral sources and patients. Demonstrate the company's core values of respect, honesty, integrity, diversity, inclusion, and safety.

Essential Job Functions

  • Manage the Patient Access team in the processing of new patient referrals, insurance benefit investigation and verifications, and procurement of authorizations
  • Establish, communicate, and maintain operating policies, processes and procedure covering functional area, to improve efficiency, quality and compliance, and related performance expectations
  • Monitor results to evaluate compliance with quality and productivity expectations and identify opportunities for improving results
  • Identify and guide the implementation of new or upgraded technology to enhance team performance
  • Establish customer service standards of excellence and ensure compliance
  • Monitor and work with associates to provide training and improve skills involved in patient coverage investigation, patient application evaluations, compliance with service standards, evaluation and maximization of reimbursement in relation to costs, efficiency, and service
  • Balance workload and manage schedules of associates to suit demand and service standards
  • Interview, select, recommend hire, train and assign department associates; develop and communicate performance metrics to assess the effectiveness of associates
  • Evaluate performance and provide counseling, cross training and coaching to associates; develop and implement staffing plans and related budgets as required
  • Communicate with external sales force to receive and provide information regarding individual account requirements and expectation and resolve customer/patient issues
  • Supervise and coach direct reports in the performance of their duties; complete performance reviews and provide feedback to direct reports
  • Perform or assist with any operations, as required to maintain workflow and to meet business needs
  • Participate in any variety of meetings and work groups to integrate activities, communicate issues, obtain approvals, resolve problems and maintain specified level of knowledge pertaining to new developments, requirements, and policies
  • Perform other related duties as assigned
  • Must be able to perform the essential job functions of this position with or without reasonable accommodation


Minimum Position Qualifications

  • High School Diploma or GED
  • 3+ years leadership experience
  • Knowledge of current medical services technology applications
  • Knowledge of medical benefits and insurance standards, investigation processes, and compliance requirements for reimbursement
  • Doctorate in Pharmacology and Pharmacist certification/licensure may be required in certain jurisdictions
  • Bilingual in Spanish/English may be required in certain jurisdictions
  • Keen understanding of technology as productivity and efficiency enhancement tools.
  • Able to identify training requirements and develop and implement training model focused to improve results
  • Proven ability to identify and implement superior customer service model
  • Strong knowledge of business and ability to analyze data to identify actions to be taken
  • Strong people and systems management skills


Desired Previous Experience/Education

  • Bachelor's Degree in Business, Marketing or similar discipline
  • Any healthcare or specialty pharmacy experience

Additional Information

All your information will be kept confidential according to EEO guidelines.


Jobs at Kroger:  To support and reward our hardworking and friendly associates, we offer much more than just a paycheck. We strive to feed your future by offering the ingredients you need to create your own recipe for success at work and in life. Our associates receive a full plate of benefits that promote their physical, emotional and financial well-being, including access to competitive health care and retirement benefits, paid time off, mental health resources, associate discounts and opportunities to learn, grow and advance. Our associates also get to help us make a difference in our communities through our Zero Hunger | Zero Waste and Framework for Action: Diversity, Equity and Inclusion plans. Visit the to learn more about our work in the communities we serve and how our associates help us be a good neighbor.

Below is a list of some of the benefits we offer our associates.

Health and Well-being Benefits:

  • Health care benefits
  • Paid time off such as vacation, sick leave, and parental leave
  • Mental and emotional support resources through our Employee Assistance Program

Financial Benefits:

  • Participation in a 401(k) plan, subject to certain eligibility requirements
  • Group term life insurance eligible
  • Eligible for an annual bonus based upon company performance
  • Associate discounts

Growth and Development Benefits:

  • Tuition assistance, college scholarships and educational leave of absence, depending on varying criteria by location and subject to certain eligibility requirements
  • Robust internal training and development resources to grow your career

We want the best for associates and our customers, and together, we strive to create a welcoming and engaging environment where you’ll love to work. If you are interested in becoming a valued member of our team, apply now. We look forward to getting to know you!

Company Overview: Kroger Family of Companies employs nearly half a million associates who serve over 11 million customers daily through a seamless shopping experience under a variety of banner names.  At The Kroger Co., we are Fresh for Everyone™ and dedicated to our Purpose: To Feed the Human Spirit®.  We are committed to creating #ZeroHungerZeroWaste communities by 2025.  Careers with The Kroger Co. and our family of companies offer competitive wages, flexible schedules, benefits and room for advancement.