Clinical Pharmacist (Long Island City)
Fidelis Care New York, New York
As a member of the Centene Medical Management/Health Services team, you’ll help innovate and execute strategies that redefine the industry standard for improving the lives and health of people. We’re a team of skilled physicians, nurses, pharmacists, social workers and health service experts who use our advanced clinical analytics to implement award winning programs, develop care, deliver partnerships, and work directly with our members to achieve outcomes that set us apart as industry leaders. Together, we’re transforming the health of communities, one person at a time.
What does it take?
What are the qualities that will help you achieve success in this role at Centene?
- Good listener
Our Medical Roles
Clinical & Nursing Opportunities at Centene
Our Clinical team is at the forefront of our purpose-driven work. Learn more about how you can help transform the health of our communities, one person at a time.
Overall Medical Management
A member of the Centene Medical Management team, we innovate and execute strategies that redefine the industry standard for improving the lives and health of people.
Concurrent Review Nurse
To ensure our members get the best quality of care, you’ll assess acute member health conditions, treatment and intervention options, and match them with providers, community and health plan resources.
Prior Authorization Nurse
You’ll ensure our members get the best quality services, assistive devices, and equipment to promote optimal health and independence in the community and help promote health and independence.
Working directly with members, interdisciplinary care team, providers and data analytics, you’ll identify member health risks and conditions and intervention and service options.
LTSS Program Specialist/Program Specialist Field Based
Working directly with our most vulnerable members, you’ll identify individual member health risks and opportunities to enhance independence, quality of life and community engagement.
You’ll use our data systems to directly assist providers, requesting services and treatments for our members.
To help support the individual needs of members and develop programs that address issues, you’ll review population health data, help design clinical programs, and develop care delivery partnerships.
Category Clinical & Nursing
**Please note - this is an office based position. Our office is currently located in Rego Park, Queens, but we will be moving to Long Island City, Queens within the next year.Qualified candidates must be comfortable working in either location.
Position Purpose: Define and develop standard and custom formularies for assigned plan.
• Conduct provider outreach for regimens in question in addition to reminders on QARR-centric goals, such as routine office visits, viral load testing, and syphilis testing
• Provide reminders to providers and members for routine office check-ups, viral load testing, and syphilis screening through opportunities made upon prior authorization requests, medication therapy management reviews, and drug utilization reviews; this will be done in collaboration with Clinical Services
• Coverage determination reviews for medications that are non-formulary or are rejecting due to smart edits designed to stop potential drug-drug interactions or therapy/ingredient duplication.
• Identify opportunities for medication therapy optimization, including (but not limited) to the following:
i. Identification of therapeutic or ingredient duplication
ii. Identification of drug-drug interactions between different ARVs and non-ARVs
iii. Modifying dosing frequency
iv. Medication consolidation (i.e. use of co-formulated products)
v. Adding or removing medication components in regimens
vi. Ensuring that regimens are complete (HAART) as recommended by national guidelines
• Outreach providers (by fax and phone) with detailed member-specific ARV medication fill history in addition to regimen assessments with potential areas of improvement
• Viral load documentation to promote viral load suppression and identify prioritization of case management.
i. Tracking viral load laboratory data obtained through case management chart reviews and/or upon submission through prior authorization requests in a secured location in the shared drive as well as through a database (spreadsheet or other platform).
• Work with members and non-specialized providers to link HIV care to specialists to improve clinical outcomes.
• Support staff training and development as required.
• Participate in internal, Federal and State audits and NCQA accreditation surveys.
• Other duties as assigned.
Education/Experience: Bachelor’s degree or advanced degree (Pharm.D., M.S.) in pharmacy. 2+ years of mail order, retail, hospital or managed care pharmacy experience or 1+ years of pharmacy residency program experience.
Licenses/Certifications: Current state’s Pharmacist license with no restrictions.
• One year of pharmacy practice experience, preferred.
• Managed care pharmacy experience, preferred.
• Pharmacy Residency Certification, preferred.
• AAHIVP certification, preferred.
• Proficiency in Microsoft Office: Excel, Word, Access; Outlook; Internet.
• Working knowledge of the Clinical Pharmacy environment.
• Proficiency in reading, writing, and speaking English.
• Knowledge of managed care pharmacy.
• Business Analysis Knowledge: Skilled to work in a fast paced environment. Must have strong analytical and problem solving skills.
• Customer Service: Skilled to communicate with all levels of management, internal and external customers.
• Ability to work well as a member of a team or alone.
• Effective Business Communication: Skilled in communicating with technical and business constituencies in writing effective business specifications and requirements.
• Flexible, accountable and adaptable with the ability to work under pressure to meet deadlines in a fast paced environment
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“Centene is an exciting company to work for, the pace at which we’re growing allows numerous advancement opportunities. Also, we foster an environment that supports and offers numerous leadership growth opportunities.”- Esmeralda Baig, SVP Operations, Complex Care Products
“I assisted with one of the Provider fairs in the community. Seeing how much we care for our community and our patients was very eye opening.”- Julie Boulch, Director, Business Implementation Health Plan Initiatives
Centene is consistently recognized for how well we treat our members, our people, and the communities we serve.Honored to be Honored
Our Hiring Process
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“Flexibility is key. Centene is a company of change.”
Started as a Referral Specialist, now a Project Manager IVSee Ashley's career path
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