Pharmacy Programs & Authorization Specialist (Remote)

Visa Hunt; United States; Hybrid; USD 27,000 - 45,000; Full time

Benefits offered by this job

Health insurance

401K and stock purchase plans

Tuition reimbursement

Paid time off plus holidays

Flexible work arrangements

Job summary

Centene is seeking a Pharmacy Technician to support the development, coordination and maintenance of the health plan's pharmacy program. The role emphasizes handling prior authorizations, formulary inquiries and provider education.

The position requires at least 3 years of pharmacy experience in managed care and a preferred Pharmacy Technician license. Remote/hybrid/work flexibility is noted along with competitive benefits.

Qualifications

• High school diploma or equivalent. 3+ years of pharmacy experience, preferably in a managed care environment.
• Current state's Pharmacy Technician license preferred.
• Medicare and/or Medicaid experience preferred.

Responsibilities

• Receive and respond to provider and pharmacy calls regarding the prior authorization and formulary process.
• Review pharmacy and override process in compliance with company and state guidelines.
• Track and trend overrides to ensure criteria have been met, audit for prior authorizations, analyze cost and utilization patterns.
• Resolve complaints and grievances related to the pharmacy network with the Pharmacy team.
• Educate providers on the health plan's pharmacy process with Provider Relations and other departments.
• Assist with pharmacy utilization review and reporting processes.
• Collaborate with Quality Improvement meeting preparation and transcription of minutes.
• Assist with member inquiries related to the formulary process.
• Performs other duties as assigned.
• Complies with all policies and standards.

Skills

Pharmacy experience

Education

High school diploma

Job description

Centene is seeking a Pharmacy Technician to support the development, coordination and maintenance of the health plan's pharmacy program. The role emphasizes handling prior authorizations, formulary inquiries and provider education.

The position requires at least 3 years of pharmacy experience in managed care and a preferred Pharmacy Technician license. Remote/hybrid/work flexibility is noted along with competitive benefits.