Clinical Pharmacist (Quality)

Centene Corporation•Remote-IL, IN

4d•$107,700 - $199,300•Remote

About The Position

This remote position works a Monday through Friday schedule from 8:00 AM to 5:00 PM Central Time and focuses on project-based quality initiatives that support clinical and formulary decision-making. Key responsibilities include creating and updating clinical policies, contacting providers regarding quality measures, ensuring clinical criteria align with state guidelines, and applying evidence-based findings to coverage policies and formulary decisions. The ideal candidate will possess strong data analysis and Microsoft Excel skills, along with the ability to critically evaluate clinical trials, treatment guidelines, and drug literature. A background in clinical pharmacy, managed care, and/or hospital is preferred. Illinois Pharmacist license is preferred but not required.

Requirements

Bachelor’s degree or advanced degree (Pharm.D., M.S.) in pharmacy.
2+ years of experience in managed care, clinical, hospital or retail pharmacy experience or 1+ years of pharmacy residency program experience.
Current state’s Pharmacist license with no restrictions.
Strong data analysis skills.
Microsoft Excel skills.
Ability to critically evaluate clinical trials, treatment guidelines, and drug literature.

Nice To Haves

Background in clinical pharmacy, managed care, and/or hospital is preferred.
Illinois Pharmacist license is preferred but not required.

Responsibilities

Define and develop standard and custom formularies for assigned plan.
Develop clinical criteria for medications, recommend plan design changes, and clinical programs to be initiated.
Monitor prior authorization requests.
Provide clinical support to internal departments and address clinical related questions.
Ensure appropriate quality controls and initiates opportunities for performance improvement in pharmacy/practice.
Develop and implement programs designed to impact DUR for both Medicaid and Medicare.
Develop, implement, and maintain policies and procedures for the pharmacy department.
Participate in the coordination of the Medicare MTM program.
Assist case management team with members including clinical rounds presentations.
Creating and updating clinical policies.
Contacting providers regarding quality measures.
Ensuring clinical criteria align with state guidelines.
Applying evidence-based findings to coverage policies and formulary decisions.