Pharmacy Coordinator-1

Centene Corporation; Austin (TX); Remote; USD 60,000 - 80,000; Full time

Job summary

A national healthcare organization is seeking a Clinical Professional for their Medical Management team. This remote role involves managing pharmacy-related processes, responding to inquiries, and ensuring compliance with guidelines. Candidates should have a high school diploma, 3+ years of pharmacy experience, and strong knowledge of Medicare or Medicaid. The position offers flexible scheduling and a comprehensive benefits package.

Benefits

Competitive pay

Health insurance

401K and stock plans

Tuition reimbursement

Flexible work schedules

Qualifications

• 3+ years of pharmacy experience in a managed care environment.
• Current state's Pharmacy Technician license preferred.
• Experience in documenting requirements and creating training materials.

Responsibilities

• Respond to provider and pharmacy calls regarding prior authorization.
• Track and trend overrides to ensure criteria are met.
• Assist providers with education on pharmacy processes.

Skills

Pharmacy experience

Knowledge of Medicare and Medicaid

Quality process improvement

Analysis tools proficiency

Education

High school diploma or equivalent

Job description

Overview

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.

This is a remote role. Working hours: Monday – Friday, 8-hour shift between the hours of 8am – 6pm CST

Responsibilities

• 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

Qualifications

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.

Compensation and Benefits

Pay Range: $19.04 - $32.35 per hour

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.

Additional information

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