Description
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 Coordinator – Fraud, Waste, and Abuse (FWA) - Remote
Job-Specific Details:
Review and respond to fraud, waste, and abuse (FWA) referrals, inquiries, and requests from internal and external stakeholders.
Support regulatory requests, reporting, and documentation related to FWA investigations and reviews.
Research and help resolve concerns involving inappropriate billing, waste, and potential FWA activity.
Communicate with members, providers, and pharmacies to gather information and support preliminary reviews.
Generate and analyze reports to identify trends, support investigations, and assist with program oversight.
Contribute to department process improvements and maintain accurate documentation.
What We’re Looking for:
3+ years of pharmacy technician experience, preferably in a managed care environment. Medicare and/or Medicaid experience preferred.
Experience in a dispensing pharmacy environment, such as retail, specialty, long-term care, or mail-order pharmacy.
Strong attention to detail, analytical thinking, and organizational skills.
Ability to collaborate effectively in a team-oriented environment while managing multiple priorities.
Proficiency with Microsoft Office applications, including Word, Excel, PowerPoint, and Outlook.
Excellent verbal and written communication skills with members, providers, pharmacies, and internal stakeholders.
Someone who brings a positive attitude and has an interest in fraud, waste, and abuse prevention, compliance, and program integrity.
Working Shift: Monday–Friday, 8:00 AM – 4:30 PM. Eastern or Central time, with a 30-minute lunch.
Position Purpose:
Perform duties to support the pharmacy department's efforts in the development, coordination, and maintenance of the health plan's pharmacy program.
Receive and respond to provider and pharmacy calls regarding pharmacy benefits.
Resolve complaints and grievances related to the pharmacy network in conjunction with the Pharmacy team.
Assist various departments in educating providers on the health plan’s pharmacy processes.
Assist with the pharmacy utilization review and reporting process.
Assist with member inquiries.
Perform other duties and activities as assigned.
Comply with all policies and standards.
Education / Experience 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.
*Please attach an up-to-date resume that meets Education / Experience requirements to your application. *
Pay Range: $19.43 - $32.98 per hourCentene 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. Actual pay will be adjusted based on an individual's skills, experience, education, and other job-related factors permitted by law, including full-time or part-time status. Total compensation may also include additional forms of incentives. Benefits may be subject to program eligibility.
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.
Qualified applicants with arrest or conviction records will be considered in accordance with the LA County Ordinance and the California Fair Chance Act
