Pharmacy Provider Liaison
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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. Pharmacy Provider Liaison - Remote Position Purpose: Assist providers & members with coordination of healthcare personnel administered drug services at preferred sites of care. Goal is to provide seamless member & provider services. This role will help prevent gaps in care for members. This role will support part of the prior authorization review process within Utilization Management within Medical Pharmacy Services. Perform duties to act as a liaison between providers, Health Plans and Corporate including investigating and resolving provider physician injectable claims issues. Communicate effectively and partner with all internal departments to ensure members and providers have a positive, successful outcome. Serve as primary contact for providers serving as a liaison between the provider and the health plan for all pharmacy concerns Receive and respond to provider related issues Review Pharmacy Report and develop case list to conduct provider/member outreach for care coordination Review Prior Authorization requests and apply the Site of Care optimization policy. Will tailor alternative sites based on member location and available providers able to service the member Attend meetings with Market Teams to assist where needed with pharmacy or medication concerns/process updates Educate providers regarding policies and procedures related to pharmacy issues; web site education, and problem solving (liaison responsibilities).
