Remote Pharmacy Coordinator: Quality & Claims Support

NEPSE Trading; United States; Remote; USD 28,000 - 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 (remote/hyr

Remote/hybrid/work schedule options

Job summary

Centene is seeking a Remote Pharmacy Coordinator to support the Eastern Time operations of our pharmacy program. The role involves provider outreach, claims review, and process improvements to promote adherence and quality.

The ideal candidate has 3+ years of pharmacy experience, strong communication, and comfort with multiple software systems. Indiana experience preferred but other eastern or central time zones will be considered.

Qualifications

• 3+ years of pharmacy experience in a managed care environment preferred.
• Strong communication skills and attention to detail required.
• Comfort navigating multiple software systems and prioritizing tasks.

Responsibilities

• Conduct provider and pharmacy outreach via calls, letters, faxes, and reporting.
• Review pharmacy claims to identify trends and opportunities for adherence improvement.
• Manage prior authorization and formulary processes per guidelines.
• Assist with pharmacy utilization review and reporting activities.
• Educate providers on pharmacy processes and collaborate with Quality Improvement.
• Handle member inquiries and support the pharmacy network operations.

Skills

Pharmacy experience

Communication skills

Organized and detail-oriented

Multi-system software navigation

Prioritization and task management

Education

High school diploma or equivalent

Tools

Web-based analysis tools

Pharmacy management software

Proprietary software systems

Job description

Centene is seeking a Remote Pharmacy Coordinator to support the Eastern Time operations of our pharmacy program. The role involves provider outreach, claims review, and process improvements to promote adherence and quality.

The ideal candidate has 3+ years of pharmacy experience, strong communication, and comfort with multiple software systems. Indiana experience preferred but other eastern or central time zones will be considered.