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Sr. Manager, Clinical Engagement Center

Navitus Health Solutions, LLC Madison, WI Full-Time
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The Manger, Clinical Engagement Center is responsible for overseeing all telepharmacy and engagement operations assuring alignment with regulatory, client, and clinical requirements.

Telepharmacy and health coaching activities focused on improving member health while providing an optimal member experience is key. Ability to develop clinical pathways aimed at improved health in a concierge-like environment to resolve pharmacy-related concerns is required. Additional focus on peer-to-peer engagement between healthcare professionals to improve prescribing practices and total cost of care will be a core function.

The Clinical Engagement Center Manager will be responsible for key performance indicators (KPI) including traditional call center metrics and clinical outcomes. Providing supervision and leadership to staff ensuring the optimal use of resources for daily operations and ensuring that staff manage calls in a professional caring manner focused on exceptional member/prescriber experience. The center will focus on excellence in telepharmacy in an atmosphere of continuous improvement.

Job Responsibilities:

  • In collaboration with Sr. Director, determine Clinical Engagement Center operational and strategic direction.
  • Recruit, maintain, and manage a high performing multi-disciplinary clinical engagement team consisting of pharmacists, nurses, health coaches and certified pharmacy technicians.
  • Draft clinical pathways and call scripts with the team.
  • Conduct medication therapy management (MTM) and expanded clinical programs in accordance with the Centers for Medicare & Medicaid Services (CMS).
  • Establish and monitor productivity, quality and customer-service standards for the team.
  • Monitor, improve and report on key performance metrics on a/an daily, weekly, monthly, quarterly and annual basis.
  • Establish quality assurance protocols, including call-recording analysis, performance scorecards, coaching feedback for team.
  • Develop a full understanding of Navitus Clients' patient experience and how the engagement center contributes to improved health and wellness.
  • Contribute valuable data insights and analysis for organizational strategic plans and reviews.
  • Build relationships with Sales and Account management departments to understand fully client demand for telepharmacy services.
  • Serve as first point of contact for technology concerns, as well as communication and implementation of processes within the call center (Email, Fax, Phone, Cisco Contact Center, Call Recording, Voice Overs, etc.).
  • Adhere to compliance and HIPAA regulations.
  • Serves as first point of contact for staff for any escalated member concerns that arise on calls.
  • Handles exceptions to routine clinical calls.
  • In collaboration with Navitus Disaster recovery team, responsible for implementing the disaster recovery systems to ensure that service to members continues with minimum disruption when phone systems, electricity, and mainframe computers go down
  • Responsible for Clinical Engagement Center on-call rotation to serve as a resource for staff.
  • Provides input into developing annual budget proposals.
  • Organizes and conducts staff meetings and serves as primary point of contact for clinical engagement center.
  • Develops subject matter expertise in URAC, NCQA, CMS, etc. standards, and other regulations and guidance that will affect the CEC processes.
  • Creates and maintains all policies and procedures related to engagement center activities.
  • Conducts audits of processes to assure compliance
Equal Opportunity Employer Minorities/Women/Protected Veterans/Disabled


Bachelors of Science in Business, Healthcare, Nursing, or Pharmacy is required

Advanced Degree with leadership skills preferred


  • Experience as a clinical call center lead is preferred.
  • Experience as a member of a multi-disciplinary team is preferred.
  • Professional PBM industry work experience is preferred.
  • Knowledge of applicable data privacy practices and laws is preferred.
  • Healthcare industry practices and HIPAA knowledge would be a plus.

Recommended skills

Industry Practices
Customer Service
Health Insurance Portability And Accountability Act (Hipaa) Compliance
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Job ID: 1300


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