Description
Who We Are - Motivated by Purpose. Powered by Clinical Expertise.
Founded in 1983, we’re a clinically-driven, tech-enabled utilization management company offering expert clinical reviews, regulatory guidance, and actionable insights to healthcare organizations.
Excellence starts with our people.
WE OFFER
- A competitive compensation package.
- Benefits include healthcare, vision and dental insurance, a generous 401k match, paid vacation, personal time, and holidays.
- Growth and training opportunities.
- A team atmosphere with fun events and prizes scheduled throughout the year.
POSITION OVERVIEW
Manager-level position responsible for end-to-end operational oversight of pharmacy operations supporting both clinical and non-clinical functions. Accountable for workflow performance, team coordination, and execution across integrated operational models. Leads cross-functional teams responsible for case progression, clinical review support, and completion activities, ensuring alignment with quality, turnaround time, and productivity expectations. Partners with clinical leadership, quality, and operations teams to drive efficiency, reduce rework, and support scalable, high-performing operational workflows.
Roles:
- Provide operational leadership for pharmacy operations workflows, including both clinical and non-clinical functions supporting IRO services (initial reviews and appeals).
- Own the execution and performance of integrated pharmacy operations, ensuring alignment across case progression, clinical review support, and completion processes.
- Lead cross-functional teams to deliver against key operational metrics, including quality, turnaround time, productivity, and backlog management.
- Drive alignment between clinical and non-clinical workflows to ensure efficient case flow, minimize rework, and optimize resource utilization.
- Partner with clinical leadership, quality, and operations teams to ensure consistency in review practices, documentation standards, and workflow execution.
- Contribute to the ongoing design, refinement, and standardization of operational workflows to support scalability and performance improvement.
- Develop team capability through coaching, performance management, and workforce planning across both clinical and non-clinical staff.
- Identify operational risks, gaps, and inefficiencies, and implement solutions to improve performance and service delivery.
Major Responsibilities or Assigned Duties:
- Lead day-to-day operations of pharmacy workflows, ensuring efficient case progression across clinical and non-clinical functions.
- Own performance outcomes for assigned operations, including quality, turnaround time, productivity, and backlog management.
- Monitor and manage workflow distribution, capacity, and staffing to ensure alignment with volume demands and service level expectations.
- Ensure effective coordination between clinical and non-clinical functions to support seamless case flow and minimize delays or rework.
- Identify and resolve operational bottlenecks, inefficiencies, and breakdowns in workflow execution.
- Establish and maintain performance standards, ensuring accountability at both individual and team levels.
- Provide direct leadership to team members, including coaching, performance management, and development of both clinical and non-clinical staff.
- Partner with quality and clinical leadership to ensure consistency in review practices, documentation, and adherence to internal and external standards.
- Support implementation and stabilization of new workflows, processes, and operational changes to improve efficiency and scalability.
- Analyze operational data and performance trends to identify opportunities for improvement and drive informed decision-making.
- Ensure readiness and operational alignment for new clients, products, or workflow changes impacting pharmacy operations.
- Maintain effective communication with cross-functional partners to ensure alignment on priorities, risks, and performance outcomes.
- Perform other duties as required to support operational performance and business needs.
Requirements
Skills and Experience:
- Minimum of 2–3 years of supervisory or leadership experience in healthcare operations, managed care, or a related environment.
- Experience supporting clinical review, quality auditing, completion, or similar operational workflows preferred.
- Clinical experience in utilization review, clinical quality auditing, or related healthcare review functions preferred
- Strong understanding of healthcare operations, including clinical review workflows, case progression, and operational support functions within pharmacy operations.
- Demonstrated leadership experience managing both clinical and/or non-clinical teams in a healthcare or managed care environment.
- Ability to manage end-to-end workflows, including coordination between clinical and non-clinical functions to drive efficient case flow.
- Strong operational and problem-solving skills, with the ability to identify bottlenecks, resolve workflow issues, and improve performance.
- Experience managing performance metrics, including quality, turnaround time, productivity, and backlog.
- Ability to work in a fast-paced environment, managing multiple priorities and shifting demands.
- Strong communication skills, with the ability to collaborate effectively across clinical, quality, and operations teams.
- Strong organizational skills and attention to detail.
- Working knowledge of medical terminology and healthcare processes.
- Knowledge of regulatory, compliance, and accreditation requirements applicable to healthcare operations.
- Proficiency in standard business tools (Microsoft Office Suite).
Education:
- Doctor of Pharmacy (PharmD) required
Work Environment:
Ability to sit at a desk, utilize a computer, telephone, and other basic office equipment is required. This role is designed to be a remote position (work-from-home).
Diversity Statement:
Diversity creates a healthier atmosphere: All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law.
Drug-Free Workplace:
This company is a drug-free workplace. All candidates are required to pass a Background Screen before beginning employment. All newly hired employees will take a Drug Screen, as well as agreeing to all necessary Compliance Regulations on their first day of employment. Employees are required to adhere to all applicable HIPAA regulations and company policies and procedures regarding the confidentiality, privacy, and security of sensitive health information.
California Consumer Privacy Act (CCPA) Information (California Residents Only):
- Sensitive Personal Info: MRIoA may collect sensitive personal info such as real name, nickname or alias, postal address, telephone number, email address, Social Security number, signature, online identifier, Internet Protocol address, driver’s license number, or state identification card number, and passport number.
- Data Access and Correction: Applicants can access their data and request corrections. For questions and/or requests to edit, delete, or correct data, please email the Medical Review Institute at [email protected].
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