Remote Clinical Pharmacist - Prior Authorization & Formulary

Centene Corporation; United States; Hybrid; USD 108,000 - 199,000; Full time

Benefits offered by this job

Competitive pay

Health insurance

401K and stock purchase plans

Tuition reimbursement

Paid time off plus holidays

Flexible work schedules

Job summary

Centene Corporation is seeking a Clinical Pharmacist to review prior authorization requests for non-formulary medications, ensuring clinical appropriateness and cost-effectiveness for members.

The role requires a valid Pharmacist license in the employment state and may involve weekend/holiday coverage as part of rotation; experience in managed care or health plan pharmacy operations is preferred.

Qualifications

• PharmD or Bachelor’s in Pharmacy with licensure in the state of employment.
• One year of prior experience in managed care, utilization management, or prior authorization preferred.
• Must be authorized to work in the U.S. without visa sponsorship now or in the future.
• Experience applying medical policy criteria for prior authorizations.

Responsibilities

• Reviews a completed prior authorization request from provider and pharmacy tech for appropriateness.
• Verifies member ID, date of birth, and eligibility in the health plan system.
• Communicates with physicians regarding plan benefits, exclusions, and formulary alternatives.
• Compiles data for reporting and supports the National P&T Committee.

Skills

Prior authorization experience

Clinical Pharmacist

Communication with physicians

Medical policy application

Education

Bachelor’s or Doctorate of Pharmacy degree

Job description

Centene Corporation is seeking a Clinical Pharmacist to review prior authorization requests for non-formulary medications, ensuring clinical appropriateness and cost-effectiveness for members.

The role requires a valid Pharmacist license in the employment state and may involve weekend/holiday coverage as part of rotation; experience in managed care or health plan pharmacy operations is preferred.