Remote Pharmacy Program Coordinator

Centene Management Company LLC; United States; Remote; USD 26,000 - 45,000; Full time

Job summary

Centene Management Company LLC is seeking a Remote Pharmacy Coordinator to support Eastern Time business hours, Monday–Friday 8:30 AM–5:00 PM. This role focuses on developing, coordinating, and maintaining the health plan's pharmacy program through quality-focused outreach and operational support.

Responsibilities include provider and pharmacy outreach, reviewing claims, and contributing to quality initiatives.

Qualifications

• 3+ years of pharmacy experience, preferably in a managed care environment.
• Medicare and/or Medicaid experience preferred.
• Prior experience using analysis tools or systems (e.g., web based, custom, proprietary).
• Experience in the implementation of quality process improvement efforts.
• Experience documenting requirements, creating training materials and working directly with end users.
• Current state's (Indiana) Pharmacy Technician license preferred.

Responsibilities

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

Skills

Pharmacy experience

Communication skills

Organized

Detail-oriented

Software systems

Education

High school diploma

Tools

Pharmacy software

Data analysis tools

Job description

Centene Management Company LLC is seeking a Remote Pharmacy Coordinator to support Eastern Time business hours, Monday–Friday 8:30 AM–5:00 PM. This role focuses on developing, coordinating, and maintaining the health plan's pharmacy program through quality-focused outreach and operational support.

Responsibilities include provider and pharmacy outreach, reviewing claims, and contributing to quality initiatives.