Clinical Pharmacist

Centene

234d • $105,600 - $195,400

About The Position

You could be the one who changes 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. As a Clinical Pharmacist, you will provide timely drug therapy for Medicaid health plan members by processing grievances/appeals, medical necessity requests, and clinical programs. You will review grievances/appeals requests and make determinations for drug products according to member benefits and coverage criteria. Additionally, you will be responsible for setting criteria for medication analysis, coordinating reports to clients, and meeting regulatory reporting requirements for drug utilization review and fraud and abuse reporting. You will develop clinical criteria for the review of non-formulary or non-preferred drug lists medications and communicate recommendations to clients. Furthermore, you will oversee the drug utilization review and medication therapy management programs at the assigned plan to meet state requirements and develop systematic reviews of prescription claims to meet strategic initiatives. You will also develop clinical edits effective at the point of sale to enhance appropriate drug utilization based on evidence-based criteria, provide clinical guidance and support to the assigned pharmacy technicians, and develop and review guideline criteria for prior authorization and non-formulary drugs in support of Pharmacy and Therapeutics Committee function and pharmacy benefit design. Ensuring and evaluating quality controls and implementing opportunities for performance improvement in pharmacy practices will also be part of your responsibilities. You will research drug information to maintain drug knowledge and disease state understanding and perform other duties as assigned while complying with all policies and standards.

Requirements

• Bachelor's degree or advanced degree (PharmD., M.S) in pharmacy.
• 3+ years of retail or hospital pharmacy experience or 1+ years of managed care pharmacy experience.
• Clinical pharmacy experience in managed healthcare preferred.
• Florida Pharmacist license with no restrictions.
• Must currently live in Florida.

Responsibilities

• Provide timely drug therapy for Medicaid health plan members by processing grievances/appeals, medical necessity requests, and clinical programs.
• Review grievances/appeals requests and make determinations for drug products according to member benefits and coverage criteria.
• 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 review of non-formulary or non-preferred drug lists medications and communicate recommendations to clients.
• Oversee the drug utilization review and medication therapy management programs at the assigned plan to meet state requirements.
• Develop systematic reviews of prescription claims to meet strategic initiatives.
• Develop clinical edits effective at the point of sale to enhance appropriate drug utilization based on evidence-based criteria.
• Provide clinical guidance and support to the assigned pharmacy technicians.
• Develop and review guideline criteria for prior authorization and non-formulary drugs in support of Pharmacy and Therapeutics Committee function and pharmacy benefit design.
• Ensure and evaluate quality controls and implement opportunities for performance improvement in pharmacy practices.
• Research drug information to maintain drug knowledge and disease state understanding.
• Perform other duties as assigned and comply with all policies and standards.

Benefits

• Competitive pay
• Health insurance
• 401K and stock purchase plans
• Tuition reimbursement
• Paid time off plus holidays
• Flexible approach to work with remote, hybrid, field or office work schedules

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Industry: Ambulatory Health Care Services
• Education Level: Bachelor's degree