Pharmacy Coordinator

Centene Corporation

8d • $19 - $33 • Remote

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. Position Purpose: Perform duties to support the efforts pharmacy department in the development, coordination and maintenance of the health plan's pharmacy program. Receive and respond to provider and pharmacy calls regarding the prior authorization and formulary process Perform review of pharmacy and override process in compliance with pharmaceutical related company and State guidelines Track and trend overrides to ensure criteria have been met, audit for prior authorizations, analyze cost and determine utilization patterns Resolve complaints and grievances related to the pharmacy network in conjunction with the Pharmacy team Assist Provider Relations and various departments with educating providers on the health plan’s pharmacy process Assist with the pharmacy utilization review and reporting process Collaborate with Quality Improvement department with various meeting preparation and transcription of minutes Assist with members’ inquiries related to the formulary process Performs other duties as assigned Complies with all policies and standards For Centene Pharmacy Services: High school diploma or equivalent. 3+ years of pharmacy experience, preferably in a managed care environment. Medicare and/or Medicaid experience preferred. Prior experience using analysis tools or systems (ex: web based, custom, proprietary, etc.). Experience in the implementation of quality process improvement efforts. Experience documenting requirements, creating training materials and working directly with end users. License/Certificate: Current state's Pharmacy Technician license preferred.

Requirements

• High school diploma or equivalent.
• 3+ years of pharmacy experience, preferably in a managed care environment.
• Prior experience using analysis tools or systems (ex: web based, custom, proprietary, etc.).
• Experience in the implementation of quality process improvement efforts.
• Experience documenting requirements, creating training materials and working directly with end users.
• Current state's Pharmacy Technician license preferred.

Nice To Haves

• Medicare and/or Medicaid experience preferred.

Responsibilities

• Perform duties to support the efforts pharmacy department in the development, coordination and maintenance of the health plan's pharmacy program.
• Receive and respond to provider and pharmacy calls regarding the prior authorization and formulary process
• Perform review of pharmacy and override process in compliance with pharmaceutical related company and State guidelines
• Track and trend overrides to ensure criteria have been met, audit for prior authorizations, analyze cost and determine utilization patterns
• Resolve complaints and grievances related to the pharmacy network in conjunction with the Pharmacy team
• Assist Provider Relations and various departments with educating providers on the health plan’s pharmacy process
• Assist with the pharmacy utilization review and reporting process
• Collaborate with Quality Improvement department with various meeting preparation and transcription of minutes
• Assist with members’ inquiries related to the formulary process
• Performs other duties as assigned
• Complies with all policies and standards

Benefits

• Centene offers a comprehensive benefits package including: competitive pay, health insurance, 401K and stock purchase plans, tuition reimbursement, paid time off plus holidays, and a flexible approach to work with remote, hybrid, field or office work schedules.

What This Job Offers

• Job Type: Full-time
• Career Level: Entry Level
• Education Level: High school or GED
• Number of Employees: 5,001-10,000 employees