Clinical Formulary Pharmacist

Centene; United States; Remote; USD 108,000 - 199,000; Full time

Benefits offered by this job

Health insurance

401K and stock purchase plans

tuition reimbursement

paid time off plus holidays

a flexible approach to work withremote

Job summary

Centene is seeking a Pharmacist to define and develop standard and custom formularies across Commercial, Medicaid, Medicare Part D, and the Health Information Marketplace. This fully remote role requires collaboration with Pharmacy & Therapeutics to optimize drug utilization and policy design.

Candidates must hold a PharmD or advanced degree, with 3+ years in managed care pharmacy or residency, and a current pharmacist license.

Qualifications

• Bachelor’s degree or PharmD/MS in pharmacy.
• 3+ years of managed care pharmacy experience or pharmacy residency.

Responsibilities

• Develop drug product review and formulary recommendations by assessing drug use trends and new drug releases.
• Analyze pharmacy cost of care, trends, and coordinate development of guidelines.
• Set criteria for medication analysis and coordinate client reports.
• Develop criteria for review of non-formulary or non-preferred drug lists and communicate with clients.
• Design clinical edits to adjudicate claims and enhance drug utilization.
• Review guideline criteria for prior authorization and non-formulary drugs for P&T Committee support.
• Research drug information to maintain knowledge for prior authorization reviews.
• Provide clinical guidance to pharmacy technicians.
• Prepare documentation for P&T Committee reviews and decisions.

Education

Pharmacy degree (PharmD/MS)

Job description

Position Purpose

Define and develop standard and custom formularies for all lines of business including Commercial, Medicaid, Medicare Part D and the Health Information Marketplace

Key Details

This is a fully remote position. Candidates located in the CST or EST time zones are preferred. During the first 6 months, the selected candidate must be available for training and work hours that provide at least 75% overlap with the team's 8:00 AM-4:30 PM PST schedule.

Responsibilities

• Develop drug product review and formulary recommendations by assessing drug use trends, new drug releases and review of primary literature
• 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
• Develop clinical criteria for review of non-formulary or non-preferred drug lists medications and communicate recommendations to clients
• Develop and design clinical edits to adjudicate claims and enhance drug utilization
• Develop and review guideline criteria for prior authorization and non-formulary drugs in support of Pharmacy and Therapeutics Committee function and pharmacy benefit design
• Research drug information to maintain drug knowledge and disease state understanding for application to prior authorization reviews
• Provide clinical guidance and support to the assigned pharmacy technicians
• Provide support documentation and develop communication for the Pharmacy &Therapeutic (P&T) Committee review process and decisions
• Performs other duties as assigned
• Complies with all policies and standards

Education and Experience

Bachelor's degree or advanced degree (PharmD., M.S) in pharmacy. 3+ years of combined managed care pharmacy or pharmacy residency program experience.

Licenses and Certifications

Current state's Pharmacist license with no restrictions.

Pay Range

$107,700.00 - $199,300.00 per year

About Centene

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

Equal Employment Opportunity

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