Specialty Pharmacy Intake Program Manager

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Job Description Summary:

JOB SUMMARY

The Specialty Pharmacy Intake Program Manager oversees the intake, referral coordination, and prior authorization processes for specialty medications. This role ensures timely patient access to therapy by managing workflows, supervising intake and prior authorization staff, and maintaining compliance with payer requirements, accreditation standards, and manufacturer programs.

MINIMUM QUALIFICATIONS AND DESIRED ATTRIBUTES

• 3-5 years of experience in specialty pharmacy, prior authorizations, or healthcare revenue cycle (Required)
• Strong understanding of specialty pharmacy workflows, benefit investigations, and prior authorization processes in both pharmacy and medical benefits (Required)
• Excellent written and verbal communication skills with the ability to interact professionally with payers, providers, and internal teams (Required)
• Experience building and leading front-end new referral processes, including benefits investigation and prior authorization (Required)
• Experience implementing SaaS prior authorization solutions.
• Experience developing and executing new programs in a startup or early-stage specialty pharmacy environment (Required)
• Experience managing limited distribution drug (LDD) programs and manufacturer-required reporting obligations (Required)
• Familiarity with hub services or patient access center operations, including manufacturer-sponsored patient support programs (Required)
• Working knowledge of revenue cycle management and denials management as it relates to specialty pharmacy intake and prior authorization (Required)
• Certified Pharmacy Technician (CPhT) - (Strongly Preferred)
• Bachelor's or associate's degree, or equivalent experience in healthcare or business administration
• Minimum 1-2 years of supervisory or team lead experience

SPECIALIZED KNOWLEDGE

• Experience with specialty pharmacy accreditation (URAC and/or ACHC)
• Familiarity with common specialty pharmacy software platforms (e.g., EPIC)
• Knowledge of dermatology, neurology, oncology, immunology, rheumatology, and rare disease therapeutic areas
• Knowledge of 340B programs
• Certified Pharmacy Technician (CPhT) preferred
• Proficiency with reporting and business intelligence tools (e.g., Excel, Power BI, Tableau) for KPI tracking and leadership dashboards
• Experience with multi-state pharmacy licensing and non-resident pharmacy compliance requirements
• Familiarity with copay assistance platforms (e.g., ConnectiveRx, Relay Health, Lash Group)

RESPONSIBILITIES AND DUTIES

• Oversee all new patient referrals and intake processes to ensure accurate and complete documentation.
• Manage prior authorization workflows, including complex cases, appeals, and peer-to-peer reviews
• Monitor key performance metrics such as turnaround time, approval rates, and denial rates; implement process improvements as needed
• Serve as the escalation point for difficult authorizations, benefit investigations, and payer-related issues
• Collaborate with clinical pharmacists, sales/liaison teams, and external providers to resolve barriers to access.
• Ensure compliance with URAC, ACHC and other specialty pharmacy accreditation requirements
• Oversee and coordinate timely scheduling of telehealth visits with pharmacists.
• Maintain up-to-date knowledge of payer policies, specialty drug requirements, and manufacturer support programs
• Generate reports on intake volume, authorization outcomes, and team productivity for leadership review
• Support continuous improvement initiatives and help develop or refine standard operating procedures
• Define, track, and report on intake SLAs - including time-to-first-contact, referral-to-dispense cycle time, and authorization turnaround - presenting results to senior leadership with corrective action plans
• Manage relationships with manufacturer hub services, patient support programs, copay assistance programs, and limited distribution drug (LDD) access programs to maximize patient therapy initiation
• Coordinate with manufacturer patient assistance programs, charitable foundations, and copay card programs to minimize out-of-pocket barriers for patients
• Ensure all referrals are fully validated and prescription-ready before handoff to the dispensing team, reducing downstream errors and delays
• Manage referral queue prioritization, volume balancing, and acuity-based triage to maximize throughput and prevent operational bottlenecks
• Capture, analyze, and act on patient and prescriber satisfaction feedback in alignment with URAC/ACHC patient management program requirements
• Drive staff adoption and best practices within specialty pharmacy software platforms; partner with IT and automation teams to identify and implement workflow improvements
• Build and maintain structured onboarding programs, role-specific training plans, SOPs, and job aids to ensure consistent and compliant team performance

Responsibilities And Duties:

Oversee all new patient referrals and intake processes to ensure accurate and complete documentation.

Manage prior authorization workflows, including complex cases, appeals, and peer-to-peer reviews.

Monitor key performance metrics such as turnaround time, approval rates, and denial rates; implement process improvements as needed.

Serve as the escalation point for difficult authorizations, benefit investigations, and payer-related issues.

Collaborate with clinical pharmacists, sales/liaison teams, and external providers to resolve barriers to access.

Ensure compliance with URAC, ACHC and other specialty pharmacy accreditation requirements.

Oversee and coordinate timely scheduling of telehealth visits with pharmacists.

Maintain up-to-date knowledge of payer policies, specialty drug requirements, and manufacturer support programs.

Generate reports on intake volume, authorization outcomes, and team productivity for leadership review.

Support continuous improvement initiatives and help develop or refine standard operating procedures.

Define, track, and report on intake SLAs - including time-to-first-contact, referral-to-dispense cycle time, and authorization turnaround - presenting results to senior leadership with corrective action plans.

Manage relationships with manufacturer hub services, patient support programs, copay assistance programs, and limited distribution drug (LDD) access programs to maximize patient therapy initiation.

Coordinate with manufacturer patient assistance programs, charitable foundations, and copay card programs to minimize out-of-pocket barriers for patients.

Ensure all referrals are fully validated and prescription-ready before handoff to the dispensing team, reducing downstream errors and delays.

Manage referral queue prioritization, volume balancing, and acuity-based triage to maximize throughput and prevent operational bottlenecks.

Capture, analyze, and act on patient and prescriber satisfaction feedback in alignment with URAC/ACHC patient management program requirements.

Drive staff adoption and best practices within specialty pharmacy software platforms; partner with IT and automation teams to identify and implement workflow improvements.

Build and maintain structured onboarding programs, role-specific training plans, SOPs, and job aids to ensure consistent and compliant team performance.

Minimum Qualifications:

High School or GED (Required)

Additional Job Description:

Work Shift:

Day

Scheduled Weekly Hours :

40

Department

Specialty Pharmacy

Join us!

... if your passion is to work in a caring environment

... if you believe that learning is a life-long process

... if you strive for excellence and want to be among the best in the healthcare industry

Equal Employment Opportunity

OhioHealth is an equal opportunity employer and fully supports and maintains compliance with all state, federal, and local regulations. OhioHealth does not discriminate against associates or applicants because of race, color, genetic information, religion, sex, sexual orientation, gender identity or expression, age, ancestry, national origin, veteran status, military status, pregnancy, disability, marital status, familial status, or other characteristics protected by law. Equal employment is extended to all person in all aspects of the associate-employer relationship including recruitment, hiring, training, promotion, transfer, compensation, discipline, reduction in staff, termination, assignment of benefits, and any other term or condition of employment