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Pharmacy Specialist (Medicare Part B Prior Authorization)

Tempe, Arizona Apply Now Job ID 1164250 Category Pharmacy Organization Envolve Schedule Full-time
Position Purpose: Conduct data analysis to aid in the development, coordination and maintenance of the health plan’s pharmacy program. Act as the “go to” person and trainer for other Pharmacy department staff.

  • Develop and analyze various reports to aid in making formulary decisions
  • Develop and update workflows and documentation of processes and procedures
  • Develop and present score cards at senior management meetings
  • Analyze and identify cost avoidance and recommend improvements
  • Perform daily reporting for operations and surveillance as required by state regulations
  • Assist with fraud and abuse analysis
  • Assist with the development of base line metrics for pharmacy programs
  • Train various Pharmacy staff, including developing and maintaining training manuals
  • Perform review of pharmacy and override process in compliance with pharmaceutical related company and State guidelines
  • Track and trend overrides to ensure criteria has been met, audit for prior authorizations, analyze cost and determine utilization patterns
  • Respond to complex provider and pharmacy calls regarding the prior authorization and formulary process
  • Assist with the pharmacy utilization review and reporting process
  • Qualifications:

    Education/Experience: Bachelor’s degree in related field or equivalent experience. 2+ years of pharmacy experience, preferably in a managed care environment.


    Preferred: License/Certification: Current state’s Pharmacy Technician license and National Certification from Pharmacy Technician Certification Board (CPhT).

    Centene is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law.

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