Pharmacy Coordinator

Centene Management Company LLC; United States; Remote; USD 26,000 - 45,000; Full time

Job summary

Centene Management Company LLC is seeking a Remote Pharmacy Coordinator to support Eastern Time business hours, Monday–Friday 8:30 AM–5:00 PM. This role focuses 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, and contributing to quality initiatives.

Qualifications

• 3+ years of pharmacy experience, preferably in a managed care environment.
• Medicare and/or Medicaid experience preferred.
• Prior experience using analysis tools or systems (e.g., web based, custom, proprietary).
• Experience in the implementation of quality process improvement efforts.
• Experience documenting requirements, creating training materials and working directly with end users.
• Current state's (Indiana) Pharmacy Technician license preferred.

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.

Skills

Pharmacy experience

Communication skills

Organized

Detail-oriented

Software systems

Education

High school diploma

Tools

Pharmacy software

Data analysis tools

Job description

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 include conducting provider and pharmacy outreach through calls, letters, faxes, and reporting; reviewing pharmacy claims to identify trends and opportunities to improve compliance and medication adherence; and supporting quality-related initiatives.

Candidates with prior PBM, health plan, and/or managed care experience are highly preferred. The ideal candidate will have 3+ years pharmacy, strong communication skills, be organized and detail-oriented, comfortable navigating multiple software systems with ability to prioritize and successfully execute multiple tasks to completion.

Indiana is highly preferred but will consider other states in eastern and central time zones.

• 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

Education & Experience

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

Pay Range: $19.43 - $32.98 per hour.

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.

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.

Centene offers a comprehensive benefits package including:

• 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 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.

Additional Information

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.