Pharmacy Coordinator

Centene Management Company LLC; United States; À distance; USD 27 000 - 45 000; Plein temps

Résumé du poste

Centene Management Company LLC is seeking a Remote Pharmacy Coordinator to support Eastern Time business hours, Monday through Friday 8:30 AM to 5:00 PM. The role centers on developing, coordinating and maintaining the health plan's pharmacy program through quality-focused outreach and operational support.

Responsibilities include provider and pharmacy outreach, reviewing claims to identify trends, supporting quality initiatives, handling prior authorization and formulary inquiries, and

Qualifications

• High school diploma or equivalent; 3+ years of pharmacy experience in managed care preferred.
• Medicare/Medicaid experience preferred.
• Experience with analysis tools or systems.

Responsabilités

• Conduct provider and pharmacy outreach via calls, letters, faxes, and reporting.
• Review pharmacy claims to identify trends and improve adherence.
• Support quality-related initiatives.
• Assist with prior authorization and formulary processes.
• Track overrides and analyze cost and utilization patterns.
• Resolve complaints related to the pharmacy network.

Connaissances

Pharmacy experience

Quality improvement

Provider outreach

Medicare/Medicaid knowledge

Formation

High school diploma

Pharmacy Technician license

Outils

Analysis tools

Description du poste

Position Purpose:

Perform duties to support the efforts pharmacy department in the development, coordination and maintenance of the health plan's pharmacy program.

Key Details:

Remote Pharmacy Coordinator role supporting Eastern Time business hours, Monday through Friday from 8:30 AM to 5:00 PM. This position supports the development, coordination, and maintenance of the health plan's pharmacy program through quality-focused outreach and operational support activities.

Responsibilities:

• Conduct provider and pharmacy outreach through calls, letters, faxes, and reporting.
• Review pharmacy claims to identify trends and opportunities to improve compliance and medication adherence.
• Support quality-related initiatives.
• 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.
• Perform other duties as assigned.
• Comply with all policies and standards.

Education/Experience (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 (Indiana) Pharmacy Technician license preferred.

Pay Range:

$19.43 - $32.98 per hour

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:

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.

Equal Opportunity / Diversity Statement:

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.

Company Culture:

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.