Clinical Services Supervisor

This role provides day to day support to Bundle Operations teammates to ensure the highest levels of patient service are met daily. This position provides general analytical support for the Bundled Operations team, including end of month reporting for all Bundled line of service customers. This position will partner closely with the reporting team within DaVita Rx to ensure that reports are identified, generated and analyzed with an eye towards customer service and process improvement. This position will work alongside the Quality, Clinical Operations and ROPS teammates to improve all Bundled Operations. Additionally, this position oversees pharmacy technicians who are actively managing claim rejections that stem from the BAT (Bundle Adjudication Tool). The supervisor will support and guide teammates regarding problem solving scenarios which include bundle eligibility discrepancies, bundle formulary rejections, and prior authorization / utilization management rejections. Teammates reporting to the individual in this position will support DaVita Rx teammates with matters relating to BAT transactions. This position will be asked to report upon performance metrics and help to ensure that departmental goals are achieved, while ensuring that patients have optimal access to critical renal medications. Special project opportunities are also highly likely.

ESSENTIAL DUTIES AND RESPONSIBILITIES

The following duties and responsibilities generally reflect the expectations of this position but are not intended to be all inclusive.

* Ensure effective, efficient day-to-day processing of bundle specific pharmacy queues

* Ensure all Bundle reports and audits are completed in a timely manner

* Ensure departmental procedures and processes are followed and completed appropriately

* Respond knowledgeably and confidently to patient and partners' inquiries with information regarding bundle-related concerns and issues

* Develop and analyze reports as requested to determine root cause of issues including but not limited to in-depth analyses and presentations of findings

* Conduct quantitative and qualitative analyses on a broad array of issues across disciplines, projects, and functional areas to determine impact on overall operations as assigned

* Support special projects as assigned

* Performance metric collection, measurement, and reporting

* Work with management in other departments to ensure maximum collaboration

* Provide leadership and direction to BAT rejection technicians in a high production environment

* Ability to train, motivate, and coach teammates to achieve continuous improvement and operational excellence

* Assist in the development and maintenance of teammate training, reference and audit tools

* Assist in the development and implementation of Standard Operating Procedures (SOPs) and job aids for all functions performed

* Develop a strong understanding of PBM claims adjudication -- work as a liaison to the PBM vendor relative to file transmission issues, software issues, formulary changes as directed, and other topics as necessary

* Propose creative solutions to manage daily workflow and unanticipated, temporary labor shortages

* Maintain absolute compliance to all applicable regulations via a thorough practice of documentation and organizational skills

* Prioritize work to meet daily and competing deadlines

* Create and maintain relationships with the DaVita Rx Pharmacy operational Directors, Managers, and Pharmacists

* Demonstrate "leadership by example" in projecting a positive attitude, and involvement in DaVita Rx teammate activities

* Manage and support direct report teammates who are expected to:

* Respond knowledgeably and confidently to facility, and possibly patient, inquiries with information regarding all areas of pharmacy concerns and other related issues

* Respond knowledgeably to internal teammates in regard to BAT processes and claims issues

* Communicate with DaVita Clinical Operations teammates with regard to prior authorization requests, coverage determination communication, claims processing, and prescription induction.

* Communicate as directed with PBM vendor

* Work with leadership team to provide feedback and documentation support to ensure departmental procedures and processes are followed and completed appropriately

* Participate in continuous quality improvement (CQI) initiatives

* Attend team meetings, phone conferences, and training as needed

* Know, understand, and follow teammate guidelines, employment policies, and department or company procedures

The shining star in this role should have:

* High School diploma or equivalent required

* Minimum of 3 years pharmacy technician experience required

* Certified Pharmacy Technician (CPhT) certification required

* Intermediate computer skills and proficiency in MS Word, Excel, and Outlook required. Access knowledge is a plus.

* Must have extensive experience and knowledge of electronic claims adjudication process, commercial insurance, Medicare Part D and Medicaid programs reimbursement rules, prior authorization requirements and regulations in the pharmaceutical industry

* Excellent organizational and leadership skills are required. Must be able to coach teammates to achieve continuous improvement.

* A strong self-starter who is capable of operating in a dynamic and fast changing environment

* Must have the ability to work in a high production environment, meet deadlines, and demonstrate critical thinking skills

* Ambitious, energetic, and willing to learn and grow

* PBM or managed care pharmacy experience is a plus

ESSENTIAL BEHAVIORS, SKILLS, AND ATTITUDES REQUIRED FOR SUCCESS IN THIS POSITION

* Commitment to DaVita's values of Service Excellence, Integrity, Team, Continuous Improvement, Accountability, Fulfillment and Fun with ability to demonstrate those positively and proactively to patients, teammates, management, physicians, and/or vendors (Village Service Partners) in everyday performance and interactions

* Strong written, verbal, and interpersonal communications skills including ability to listen attentively and to communicate information clearly and effectively

* Demonstrated ability to work well with cross-functional groups

* Demonstrated interpersonal, collaborative, and relationship-building skills; ability to interact positively with teammates at all levels across the company

* Approachable and open

* Demonstrated professionalism and courtesy in responding to phone calls and emails

* Demonstrated proficiency in consultative skills when addressing complex inquiries

* Demonstrated strengths in organizational, attention-to-detail, follow-through, analytical, reasoning, critical thinking, and problem solving skills

* Strong analytical skills with the ability to seek underlying assumptions through probing, questioning, and listening; ability to perform root cause analysis and participate in improvement initiatives

* Strong customer service skills and commitment to service excellence

* Demonstrated ability to work in a team, facilitate effective team interactions, and to foster a positive work environment; willingness to assist teammates in order to achieve departmental goals

* Demonstrated ability to maintain absolute confidentiality concerning information accessed

The DaVita Village Difference

* Industry-leading patient care with clinical outcomes ranked above the national average.

* Dynamic leadership grounded in Core Values, Mission and clearly defined goals for you.

* Diverse, team-driven culture that supports you.

* Commitment to developing you and the chance to explore multiple career paths.

* Stability and strong financial results - 10 years of steady revenue growth.

* Performance-based compensation and rewards for your hard work.

* A commitment to the greater good: We are a community first, a company second.

To learn more about DaVita Rx, including a video, please click here.

Go to http://careers.davita.com/ to learn more or apply.

To learn more about our Village and the world of dialysis, click here.

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DaVita is an equal opportunity/affirmative action employer. As such, DaVita makes hiring decisions solely on the basis of qualifications and experience, and without regard to race, color, religion, sex, gender identity, sexual orientation, national origin, disability or protected veteran status.

We maintain a drug-free workplace and perform pre-employment substance abuse testing and background verification checks.