Pharmacy Provider Liaison

Centene Corporation; Georgia (VT); Remote; USD 10,000 - 60,000; Full time

Job summary

Centene Corporation is seeking a Pharmacy Provider Liaison to enhance member and provider services related to pharmacy care. This remote role requires coordination of healthcare personnel administered drug services, aiming to ensure seamless services for our members. The ideal candidate will have a bachelor's degree and significant experience in the health and pharmacy sectors, providing excellent customer service and problem-resolution capabilities.

Benefits

Competitive pay

Health insurance

401K and stock purchase plans

Tuition reimbursement

Paid time off

Flexible work schedules

Qualifications

• 3+ years of experience in healthcare/medical or pharmacy related roles.
• Knowledge of health care, managed care, Medicare or Medicaid preferred.
• Claims billing/coding knowledge preferred.

Responsibilities

• Assist providers & members with drug services coordination.
• Act as a liaison between providers and the health plan for pharmacy concerns.
• Review prior authorization requests and support care coordination.

Skills

Customer service

Conflict-resolution

Problem-solving

Education

Bachelor’s degree in healthcare related field

Job description

1 week ago Be among the first 25 applicants

You could be the one who changes everything for our 28 million members as a clinical professional on our Medical Management/Health Services team. Centene is a diversified, national organization offering competitive benefits including a fresh perspective on workplace flexibility.

Pharmacy Provider Liaison - Remote

Position Purpose Assist providers & members with coordination of healthcare personnel administered drug services at preferred sites of care. Goal is to provide seamless member & provider services. This role will help prevent gaps in care for members. This role will support part of the prior authorization review process within Utilization Management within Medical Pharmacy Services.

• Perform duties to act as a liaison between providers, Health Plans and Corporate including investigating and resolving provider physician injectable claims issues.
• Communicate effectively and partner with all internal departments to ensure members and providers have a positive, successful outcome.
• Serve as primary contact for providers serving as a liaison between the provider and the health plan for all pharmacy concerns
• Receive and respond to provider related issues
• Review Pharmacy Report and develop case list to conduct provider/member outreach for care coordination
• Review Prior Authorization requests and apply the Site of Care optimization policy. Will tailor alternative sites based on member location and available providers able to service the member
• Attend meetings with Market Teams to assist where needed with pharmacy or medication concerns/process updates
• Educate providers regarding policies and procedures related to pharmacy issues; web site education, and problem solving (liaison responsibilities)
  
  

Education/Experience Bachelor’s degree in healthcare related field preferred. 3+ years of combined public relations (healthcare/medical) and pharmacy related experience. Knowledge of health care, managed care, Medicare or Medicaid preferred. Claims billing/coding knowledge preferred.

License/Certification CPhT license preferred. Valid driver’s license (Remote - No travel)

Working shift - Between hours of 830 AM to 600 PM EST. Can consider later shift changes with expansion into western states in future. Possible Saturday, 900 AM to 100 PM EST, no more than once per month, if needed.

Job Specific Details

• Current markets are FL, GA, & NY, knowledge of these states is helpful.
• Healthcare/medical and pharmacy experience to support in understanding this role (pharmacy technicians, medical assistants, LPNs, etc.).
• Excellent customer service, patience, conflict-resolution, and strong problem-solving skills are needed.
  
  

Pay Range $26.50 - $47.59 per hour

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. Total compensation may also include additional forms of incentives.

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

Seniority level

• Seniority level

  Not Applicable

Employment type

• Employment type

  Full-time

Job function

• Job function

  Health Care Provider

• Industries

  Hospitals and Health Care and Insurance

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