Regional Claims Manager manages the operations of an insurance claims department to meet operational, financial, and service requirements. Oversees the intake and processing of insurance claims for personal, property, or casualty loss based on coverage, appraisal, and verifiable damage. Being a Regional Claims Manager manages appraisal and examination staff and processes. Assures timely and proper disposition of claims based on policy provisions. Additionally, Regional Claims Manager recommends and implements best practices to ensure complete and thorough claim settlements, legal reviews, and investigations following company policies and insurance industry regulations. Determines the value of settlements for escalated claims. Manages negotiations of settlements and administration of claims in litigation. Typically requires a bachelor's degree. Typically reports to top management. The Regional Claims Manager typically manages through subordinate managers and professionals in larger groups of moderate complexity. Provides input to strategic decisions that affect the functional area of responsibility. May give input into developing the budget. To be a Regional Claims Manager typically requires 3+ years of managerial experience. Capable of resolving escalated issues arising from operations and requiring coordination with other departments. (Copyright 2024 Salary.com)
Position Summary:
The Retail Pharmacy Manager is responsible for the coordination of clinical services, medication use evaluation, adverse drug reactions, reporting program and staff development program. Provides age appropriate pharmaceutical care and patient information to the neonatal, pediatric, adolescent, adult and geriatric customers of Winner Regional Health. Provides pharmaceutical care by following established standards and practices consistent with hospital policy and professional practice standards as well as state and federal law. Works within the dictates of hospital administration and the hospital medical staff.
The Retail Pharmacy Manager reviews, interprets and dispenses both prescription and non-prescription medication to patients. The Retail Pharmacy Manager takes an active role in responding to prescription issues and advising providers on the selection, dosage, interaction and side effects of medications. Counsel patients on the medication prescription including but not limited to: proper administration, possible side effects, expected response, storage and any other questions posed by the patient. Monitors the health and progress of patients in response to drug therapy. Must be able to learn and utilize new technology as the profession of pharmacy evolves.
The Retail Pharmacy Manager reviews and interprets provider orders, provides drug information, assists in problem solving, and provides other aspects of pharmaceutical care. Duties may consist of unit dose dispensing, IV Admixtures, outpatient prescriptions, navigating the electronic medical record, compounding, and working with automated dispensing devices. The Retail Pharmacy Manager utilizes appropriate age – related patient information to assess the pharmaceutical needs of patients, which may include provision of pharmaceutical care to neonatal, pediatric, adolescent, adult and geriatric patients. The pharmacist follows all established regulations and standards that govern the practice of pharmacy. Demonstrates good written and verbal communication skills. Must be able to learn and utilize new technology as the profession of pharmacy evolves. Provides oversite and clinical supervisor for pharmacy services and pharmacy support personnel.
Pharmacy services at Winner Family Drug may include involvement in acute care surgery, neurology, cardiology, pediatrics, oncology, infusion services, intensive care, general medicine, dialysis, transplant, antimicrobial stewardship, and medication reconciliation. May include decentralized clinical functions, such as direct patient interaction/Interdisciplinary team rounding, chart reviews, customer or patient counseling, collecting accurate medication list. May also include centralized clinical functions, such as checking and dispensing medications and overseeing the clinical functions of the IV room.
When students are providing patient care, treatment, and/or services as a part of their training, any/all employees may be asked to supervise the students.
Other duties as assigned.
Requirements:Education/Experience:
Graduate from an accredited school of pharmacy.
Required Credentials (Licensure, Certification, or Registration):
Must have current license to practice pharmacy in the State of South Dakota.
Employment Variables:
Retail Pharmacy hours are 8:30AM to 6:00PM Monday thru Friday and 8:00AM to 12:00PM on Saturday.
Hours worked will depend upon work status of employee and workload requirements.
Initial Tuberculosis (TB) test and drug screening is required by Winner Regional Health. Rubella titer will also be drawn upon hire and immunization is required if no past exposure or indication of immunization. Required to wear name tag provided by WRH and to follow the dress code of WRH.
Job Knowledge and Skills:
Ability to read, write, speak and understand the English language. Excellent oral and written communication skills.
Ability to deal with people in a professional manner. Problem solve effectively. Able to demonstrate technical and clinical competency and expertise in pharmacy practice and able to follow policies and procedures. Supervision and leadership experience.
Direct Supervisor:
Chief Executive Officer
PART II: CODE OF CONDUCT
Honesty We will do the right thing at all times, even if it is difficult, maintaining strong, ethical practices. We protect the confidentiality of others, including patients, staff and the facility as a whole. We will take responsibility for our actions.
Expertise We will demonstrate superior judgment, training and skill, at all times, demonstrating professionalism while doing so. We will perform all aspects of our job to the best of our ability, utilizing all resources and tools available.
Approachability We will be non-judgmental, friendly, and open and willing to listen to everyone we come into contact with while performing our duties. We are humble and learn from others.
Respect We will be understanding and sensitive to others’ feelings; caring and responding in a manner that sets them at ease, keeping the situation in perspective without minimizing others’ feelings or reactions. We will listen to others with full attention in a sincere, civil fashion, being careful not to be judgmental of the speaker. We maintain composure when facing conflict and avoid jumping to conclusions and defaming another’s name.
Teamwork We willingly work together with a common approach, trusting and supporting members of our organization, using our skills and resources, sharing information to achieve a common aim.
PART III: STANDARDS OF CONDUCT FOR LEADERS
Accountability
Communication
Integrity
Mentor-Empower
Organizational Understanding/Integration
PART IV: ESSENTIAL FUNCTIONS
Essential functions are critical or fundamental to the performance of the job. They are the major functions for which the person in the job is held accountable. Following are the essential functions of the job, along with the corresponding performance standards.
FUNCTION
Supervision and Support
Medical Staff Involvement
Maintain a Knowledge of Therapeutics
Strategic Focus
PART V: COMPLIANCE
Compliance Must comply with the Corporate Compliance Policy and all laws, rules, regulations and standards of conduct relating to the position. The employee has a duty to report any suspected violations of the law or the standards of conduct to the Compliance Officer or the Chief Executive Officer.
PART VI: PHYSICAL AND MENTAL REQUIREMENTS
General Activity
In a regular workday, employee may:
Motion
Employee is required: (In terms of a regular workday, "Occasionally" equals 1% to 33%, "Frequently" 34% to 66%, "Continuously", greater than 67%.)
Physical Demand
Employee’s job requires he/she carry and lift loads from the floor, from 12 inches from the floor, to shoulder height and overhead. Employee’s job requires a pushing/pulling force to move a load (not the weight of the load).
Physical Demand Classification: Carrying/lifting weight and pushing/pulling force:
Sensory Requirements:
Environmental Factors
Yes/No Explanation (if Yes)
Emotional/Psychological Factors
Yes/No Explanation (if Yes)
PART VII: JOB RELATIONSHIPS
Supervises
0 No supervisory responsibilities
1 Supervisory responsibility
# Direct Reports: 7
# Indirect Reports:
Age of Patient Populations Served
Internal Contacts
External Contacts
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