Clinical Pharmacist: Prior Authorization (Remote/Hybrid)

Centene Corporation; Town of Florida (NY); Hybrid; USD 108,000 - 199,000; Full time

Benefits offered by this job

Competitive pay

Health insurance

401K and stock plans

Tuition reimbursement

Paid time off

Job summary

Centene Corporation is seeking a Clinical Pharmacist to process prior authorization requests for non-formulary medications, ensuring clinical appropriateness and cost-effective therapies.

The role requires an active pharmacist license, a PharmD or BPharm, and at least one year of experience, with weekend/holiday rotations to support business needs. You will verify IDs, eligibility, coverage, and communicate with physicians about plan benefits, alternatives, and limits.

Qualifications

• Bachelor’s or Doctorate of Pharmacy degree and licensed pharmacist.
• Experience in managed care, utilization management, prior authorization preferred.
• Ability to work with health plan pharmacy operations and PM/IH processes.

Responsibilities

• Review prior authorization requests for non-formulary medications for clinical appropriateness.
• Verify member ID, date of birth, eligibility, and plan benefits.
• Apply medical policy criteria to determine approval on a case-by-case basis.
• Communicate with physicians regarding plan benefits, exclusions, and formulary alternatives.
• Compile data for reporting on drug utilization and formulary decisions.
• Participate in weekend/holiday coverage rotations to support business needs.

Skills

Managed care

Utilization management

Prior authorization

Health plan operations

Education

Pharmacy degree (B.Pharm/PharmD)

Job description

Centene Corporation is seeking a Clinical Pharmacist to process prior authorization requests for non-formulary medications, ensuring clinical appropriateness and cost-effective therapies.

The role requires an active pharmacist license, a PharmD or BPharm, and at least one year of experience, with weekend/holiday rotations to support business needs. You will verify IDs, eligibility, coverage, and communicate with physicians about plan benefits, alternatives, and limits.