Clinical Formulary Pharmacist

Centene Corporation•Remote-CA, CA

1d•$107,700 - $199,300•Remote

About The Position

This is a remote position where you could change everything for our 28 million members as a clinical professional on our Medical Management/Health Services team. Centene is a diversified, national organization offering competitive benefits including a fresh perspective on workplace flexibility. The role involves defining and developing standard and custom formularies for all lines of business, including Commercial, Medicaid, Medicare Part D, and the Health Information Marketplace. You will assess drug use trends, new drug releases, and review primary literature to develop drug product recommendations. Analyzing pharmacy cost of care and trends, coordinating the development of appropriate use protocols and guidelines, and setting criteria for medication analysis are key responsibilities. You will also coordinate reports to clients and meet regulatory reporting requirements for drug utilization review and fraud and abuse reporting. Developing clinical criteria for reviewing non-formulary or non-preferred drug list medications and communicating recommendations to clients, as well as developing and designing clinical edits to adjudicate claims and enhance drug utilization, are also part of the role. Additionally, you will develop and review guideline criteria for prior authorization and non-formulary drugs to support the Pharmacy and Therapeutics Committee function and pharmacy benefit design. Researching drug information to maintain drug knowledge and disease state understanding for prior authorization reviews and providing clinical guidance and support to assigned pharmacy technicians are expected. You will also provide support documentation and develop communication for the Pharmacy &Therapeutic (P&T) Committee review process and decisions. Performs other duties as assigned and complies with all policies and standards.

Requirements

Bachelor’s degree or advanced degree (PharmD., M.S) in pharmacy.
3+ years of combined managed care pharmacy or pharmacy residency program experience.
Current state’s Pharmacist license with no restrictions.

Responsibilities

Define and develop standard and custom formularies for all lines of business including Commercial, Medicaid, Medicare Part D and the Health Information Marketplace
Develop drug product review and formulary recommendations by assessing drug use trends, new drug releases and review of primary literature
Analyze pharmacy cost of care, trends, and coordinate the development of appropriate use protocols and guidelines
Set criteria for medication analysis, coordinate reports to clients, meet regulatory reporting requirements for drug utilization review and fraud and abuse reporting
Develop clinical criteria for review of non-formulary or non-preferred drug lists medications 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 function and pharmacy benefit design
Research drug information to maintain drug knowledge and disease state understanding for application to prior authorization reviews
Provide clinical guidance and support to the assigned pharmacy technicians
Provide support documentation and develop communication for the Pharmacy &Therapeutic (P&T) Committee review process and decisions
Performs other duties as assigned
Complies with all policies and standards