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.
Clinical Pharmacist - Provider performance - Medicaid, Medicare & STARs - AZ
Position Purpose: Define and develop standard and custom formularies for assigned plan.
Develop clinical criteria for review of medications, recommend plan design changes and communicate recommendations to clients
Monitor and review prior authorization requests for medications
Develop and design clinical edits to adjudicate claims and enhance drug utilization
Analyze pharmacy cost of care, trends, and coordinate the development of appropriate use protocols and guidelines
Set criteria for medication analysis, coordinate reports to clients, meet regulatory reporting requirements for drug utilization review and fraud and abuse reporting
Research drug information to maintain drug knowledge and disease state understanding for application to prior authorization reviews
Participate in the development and implementation of medication therapy management programs
Provide clinical guidance and support to various departments and address clinical related questions
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. Arizona licensed pharmacist, preferred. If not, Arizona licensed must be willing to be AZ licensed within 6 months.
Highly desired skills & experience:
Medicare & Medicaid
Medicare Pharmacy STARs knowledge
Interaction with Members, Vendors & Providers
Medicaid and state level reporting
HEDIS
Excel
Job specific details:
ALTCS
Medicaid & State required reporting with interactions with members, providers and pharmacy.
Medicare pharmacy STARS measure support
Interaction and support of HEDIS quality measures
Performance and target outreach
Provider performance meetings
Working shift: 8am - 5pm Monday - Friday (Arizona Time)
Pay Range: $103,500.00 - $191,600.00 per year
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. Total compensation may also include additional forms of incentives.
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.
