Clinical Audit Coordinator (Pharmacy)
About The Position
Centene is seeking a Pharmacy Clinical Audit Coordinator to play a key role in pharmacy quality and compliance operations. In this position, you will leverage your pharmacy expertise to audit prior authorization activities, identify opportunities for process improvement, support clinical training initiatives, and help maintain the integrity of critical pharmacy systems and data. If you are a licensed pharmacy technician who enjoys problem-solving, analyzing trends, improving processes, and collaborating across teams, this role offers the opportunity to make a meaningful impact beyond traditional pharmacy operations.
Requirements
- Pharmacy technician (CPhT) with experience working with Compass, TruCare, or CareCentral.
- Quality assurance on MedPharm (TruCare, ComPass and CareCentral) prior authorization requests.
- Microsoft Excel & Access.
- High school diploma or equivalent.
- 2+ years of pharmacy technician experience in a managed care or healthcare setting.
- Audit experience preferred.
Nice To Haves
- Clinical understanding of Medicare, Medicaid, Exchange and Commercial plans is a plus.
- Current State’s licensure or Certified Pharmacy Technician (CPhT), preferred.
Responsibilities
- Assist with pharmacy clinical training programs and audits of clinical systems entry and/or processes.
- Assists with auditing staff and vendor partners in accordance with established CMS guidelines.
- Partner with business groups to identify and resolve errors in data and reporting, and present findings and recommendations for improvement to management.
- Assist with the administration of audit processes and tools related to prior authorizations, appeals, quality improvement, star measurement reviews, inter-rater reliability and data entry.
- Assess training needs and identify, select or develop appropriate training programs including training aids and materials.
- Assist with training staff in the use of audit tools and identification of patterns or trends that require additional training or corrective action.
- Maintain records of training activities and employee progress.
- Participate in Quality and Advisory committees or provider education meetings.
Benefits
- competitive pay
- health insurance
- 401K
- stock purchase plans
- tuition reimbursement
- paid time off plus holidays
- a flexible approach to work with remote, hybrid, field or office work schedules
Stand Out From the Crowd
Upload your resume and get instant feedback on how well it matches this job.
What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Education Level
High school or GED
