Description
Position Purpose:
Perform duties to support the efforts pharmacy department in the development, coordination and maintenance of the health plan's pharmacy program.
Key Details: Current state's Pharmacy Technician license strongly preferred.
- 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
Education/Experience:
High school diploma or equivalent. 3+ years of pharmacy experience, preferably in a managed care environment. Medicare and/or Medicaid experience preferred.
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.
At Centene, we connect people to the care they need to live healthier lives — and the work you do here makes that impact real every day. You’ll take on meaningful challenges that directly support individuals, families, and communities, building your skills while making healthcare more accessible and effective. It’s work with a purpose you can see, backed by a team committed to improving lives well beyond the workday.
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. 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
