Senior Clinical Pharmacist Remote Formulary & Programs

Centene Corp.; 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 and holidays

Flexible work arrangements

Job summary

Centene Corp. is seeking a Pharmacist to define, develop, and maintain standard and custom formularies and clinical edits for complex medications. You will monitor prior authorization reviews, design adjudication rules, and analyze drug utilization trends to support cost-effective care.

The role requires a PharmD or equivalent, a current pharmacist license, and 4+ years in mail order, retail, hospital, or managed care settings. Flexible work arrangements may apply.

Qualifications

• Bachelor's degree or PharmD in Pharmacy required.
• 4+ years of mail order, retail, hospital, managed care pharmacy experience or residency.
• Current state's Pharmacist license with no restrictions.

Responsibilities

• Define and develop standard and custom formularies for complex or specialized medications.
• Develop criteria for review of complex medications and communicate recommendations to clients.
• Monitor and review prior authorization/appeal requests for complex medications.
• Develop and design clinical edits to adjudicate claims and enhance drug utilization.
• Analyze pharmacy cost of care, trends, and coordinate use protocols and guidelines.
• Set criteria for medication analysis and regulatory reporting requirements.
• Develop and implement medication therapy management programs.
• Evaluate program performance and ensure implementation of changes.
• Provide clinical guidance to multiple departments.

Skills

Clinical guidelines

Prior authorization review

Drug utilization review

Communication with departments

Education

Bachelor's degree or PharmD in Pharmacy

Job description

Centene Corp. is seeking a Pharmacist to define, develop, and maintain standard and custom formularies and clinical edits for complex medications. You will monitor prior authorization reviews, design adjudication rules, and analyze drug utilization trends to support cost-effective care.

The role requires a PharmD or equivalent, a current pharmacist license, and 4+ years in mail order, retail, hospital, or managed care settings. Flexible work arrangements may apply.