Clinical Account Manager

Centene Management Company LLC; Missouri; Hybrid; USD 108,000 - 199,000; Full time

Benefits offered by this job

Health insurance

401K and stock purchase plans

Tuition reimbursement

Paid time off and holidays

Flexible remote/hybrid/field schedules

Job summary

Centene is seeking a Clinical Pharmacist to provide clinical expertise in designing benefits and clinical programs to optimize therapeutic outcomes while maintaining economic efficiency in medication therapy. Remote position with approximately 10% travel.

The role involves interfacing with payers, clients, and internal teams to develop and present performance reviews and conduct drug utilization analyses. Ideal candidates will have PharmD/RPh licensure, 3+ years in clinical pharmacy operations

Qualifications

• Bachelor’s degree and licensed qualification in pharmacy (PharmD., RPh).
• 3+ years of experience in Clinical pharmacy operations or case management in specialty pharmacy preferred.
• Direct experience interfacing with payers and/or manufacturers preferred.

Responsibilities

• Provide clinical expertise to clients, explain clinical programs, and communicate new practice or clinical information to clients.
• Develop and present performance reviews in conjunction with client account team.
• Perform clinical data and drug utilization review analysis to meet client requirements and requests.
• Collaborate with Clinical Pharmacists to enhance drug utilization review program and prior authorization review process.
• Provide input into the RFP process and work with Marketing and Sales to facilitate timely response and data analysis.
• Ensure client clinical needs are met, including formulary management and clinical programs.
• Consult with clients to develop and implement appropriate clinical interventions and claim adjudication edits.

Skills

Clinical pharmacy

Payer interfacing

Drug utilization reviews

Formulary management

Education

PharmD./RPh

Bachelor’s degree in pharmacy

Job description

Position Purpose:

Provide clinical expertise to clients in designing benefits/clinical programs to optimize therapeutic outcomes while maintaining economic efficiency in the delivery of medication therapy. Interface with external clients and marketing staff to facilitate the development of clinical products that maximize cost effective medication benefits.

Key Details:

• This is a remote position, with approximately 10% travel required.
• Provide expertise in benefit design planning methods and strategies
• Provide clinical expertise to clients, explain clinical programs, and communicate new practice or clinical information to clients
• Develop and present performance reviews in conjunction with client account team
• Perform clinical data and drug utilization review analysis to meet client requirements and requests
• Collaborate with Clinical Pharmacists to enhance drug utilization review program and prior authorization review process and assist with related activities
• Provide input into the Request for Proposal process and work with Marketing and Sales to facilitate timely response and data analysis
• Ensure that client clinical needs are met, including formulary management, benefit design, drug utilization review and clinical programs
• Participate in the development and management of customized clinical business plans appropriate for each client, including the evaluation of current client program and restrictions (prior authorization, quantity limits, age limits) to determine appropriate utilization of drug therapy
• Consult with clients to develop and implement appropriate clinical interventions and claim adjudication edits.
• Participate in the development of disease state management modules by interfacing with company partners to improve array of marketable products
• Performs other duties as assigned
• Complies with all policies and standards

Acaria: Education/Experience:

Bachelor’s degree and licensed qualification in pharmacy (PharmD., RPh). 3+ years of experience in Clinical pharmacy operations or case management experience in specialty pharmacy preferred. Direct experience interfacing with payers and/or manufacturers preferred.

License/Certification:

Current state’s pharmacy license with no restrictions

Pay Range:

$107,700.00 - $199,300.00 per year

Company Description:

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.

Benefits:

• competitive pay
• health insurance
• 401K and stock purchase plans
• tuition reimbursement
• paid time off plus holidays
• 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.

Equal Opportunity & Diversity:

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.

Centene is committed to helping people live healthier lives.

We provide access to high-quality healthcare, innovative programs and a wide range of health solutions that help families and individuals get well, stay well and be well.