Clinical Formulary Pharmacist

Centene Corporation

5d•$107,700 - $199,300•Remote

About The Position

Define and develop standard and custom formularies for all lines of business, including Commercial, Medicaid, Medicare Part D, and the Health Information Marketplace. This is a fully remote position; candidates in the CST or EST time zones are preferred. During the first six months, the selected candidate must be available for training and work hours that provide at least 75% overlap with the team’s 8:00 AM–4:30 PM PST schedule. The role develops drug product reviews and formulary recommendations, assesses drug-use trends and new drug releases, and reviews primary literature. It analyzes pharmacy cost of care and trends, coordinates appropriate-use protocols and guidelines, and supports pharmacy benefit design and Pharmacy and Therapeutics Committee functions. The pharmacist also develops clinical criteria and edits, researches drug and disease-state information for prior authorization reviews, provides guidance to pharmacy technicians, and supports P&T Committee documentation and communications. Other duties may be assigned, and the role must comply with all policies and standards.

Requirements

Bachelor’s degree or advanced degree (PharmD or M.S.) in pharmacy.
At least 3 years of combined managed care pharmacy or pharmacy residency program experience.
Current pharmacist license in the applicable state, without restrictions.
During the first six months, availability for training and work hours with at least 75% overlap with the team’s 8:00 AM–4:30 PM PST schedule.

Nice To Haves

Candidates located in the CST or EST time zones are preferred.

Responsibilities

Develop drug product reviews and formulary recommendations by assessing drug-use trends, new drug releases, and primary literature.
Analyze pharmacy cost of care and trends, and coordinate the development of appropriate-use protocols and guidelines.
Set criteria for medication analysis and coordinate reports to clients.
Meet regulatory reporting requirements for drug utilization review and fraud and abuse reporting.
Develop clinical criteria for reviewing medications on non-formulary or non-preferred drug lists and communicate recommendations to clients.
Develop and design clinical edits to adjudicate claims and enhance drug utilization.
Develop and review guideline criteria for prior authorization and non-formulary drugs in support of Pharmacy and Therapeutics Committee functions and pharmacy benefit design.
Research drug information to maintain drug knowledge and disease-state understanding for prior authorization reviews.
Provide clinical guidance and support to assigned pharmacy technicians.
Provide supporting documentation and develop communications for the Pharmacy and Therapeutics Committee review process and decisions.
Perform other duties as assigned.
Comply with all policies and standards.