Remote Lead, Clinical Pharmacy Operations

Centene Management Company LLC; California; Hybrid; USD 108,000 - 199,000; Full time

Job summary

Centene Management Company LLC is seeking a Manager of Clinical Pharmacy Operations to lead and advance clinical pharmacy programs remotely. The role focuses on formulary development, drug utilization review, and medication therapy management while aligning with Medicare/HEDIS quality standards.

Candidates should have a Doctor of Pharmacy degree and 4+ years in managed care pharmacy, including leadership. Experience with Medicaid requirements and cross-functional collaboration is highly

Qualifications

• Doctor of Pharmacy degree from an accredited school.
• One to three years clinical pharmacy experience including formulary development, drug utilization review, and/or medication therapy management.
• Four years progressively responsible positions within managed care pharmacy with a minimum of two years in a management role.
• Public speaking experience.

Responsibilities

• Directs and manages clinical pharmacy activities through subordinate staff to enhance the quality of pharmaceutical care and promote cost-effective utilization of pharmaceuticals for members.
• Responsible for the development, implementation and ongoing maintenance of clinical pharmacy programs including but not limited to clinical quality assurance programs, formulary management, drug utilization review, compliance and/or education.
• Coordinates clinical efforts with other department functional areas to ensure implementation of cohesive programs.
• Performs quality assurance monitoring of staff to ensure best practices are met and validates that clinical pharmacy programs meet applicable regulatory and compliance standards, such as Medicare Star ratings, HCQA HEDIS measures, and/or regulations, etc.
• Oversees and/or develops clinical recommendations and guidelines for approval by the Pharmacy and Therapeutics committee.
• Monitors clinical advancements and changes in evidence-based pharmacy practice to ensure appropriate coverage of the most safe and effective pharmaceuticals and/or implementation of effective programs.
• Oversees compliant administration of the pharmacy benefit.
• Acts as clinical pharmacy liaison to outside agencies and providers as well as the primary point of contact for responsible area on clinical pharmacy issues as needed.
• Performs other duties as assigned.
• Complies with all policies and standards.

Skills

Leadership

Managed care

Clinical pharmacy

Drug Utilization Review

Prior Authorization

Claims adjudication

Formulary management

Public speaking

Education

Doctor of Pharmacy

Job description

Centene Management Company LLC is seeking a Manager of Clinical Pharmacy Operations to lead and advance clinical pharmacy programs remotely. The role focuses on formulary development, drug utilization review, and medication therapy management while aligning with Medicare/HEDIS quality standards.

Candidates should have a Doctor of Pharmacy degree and 4+ years in managed care pharmacy, including leadership. Experience with Medicaid requirements and cross-functional collaboration is highly