Senior Clinical Pharmacist - Remote, High-Impact Care

Centene Corporation; Florida; Híbrido; USD 108.000 - 199.000; Jornada completa

Ventajas ofrecidas por este puesto de trabajo

Competitive pay

Health insurance

401K and stock purchase plans

Tuition reimbursement

Paid time off plus holidays

Flexible work arrangements

Descripción de la vacante

Centene Corporation is seeking a Pharmacist to define and develop standard and custom formularies for complex medications for assigned plans. The role involves developing clinical criteria, monitoring prior authorization requests, and designing clinical edits to adjudicate claims, while supporting clinical program initiatives and regulatory reporting.

Qualifications include a Pharm.D. or MS in pharmacy with 4+ years of pharmacy experience in mail order, retail, hospital, or managed care.

Formación

• Bachelor's degree or advanced degree in pharmacy (Pharm.D., MS).
• 4+ years of mail order, retail, hospital, managed care pharmacy experience or residency.

Responsabilidades

• Develop clinical criteria for review of complex medications and recommend plan design changes.
• Monitor and review prior authorization/appeal requests for complex medications.
• Design clinical edits to adjudicate claims and improve drug utilization.
• Analyze pharmacy cost of care, trends, and develop use protocols and guidelines.
• Set criteria for medication analysis and report to clients.
• Develop and implement medication therapy management programs.
• Evaluate program performance and implement changes.
• Ensure quality controls and opportunities for improvement.
• Research drug information to support prior authorization reviews.
• Provide clinical guidance to departments and answer clinical questions.
• Provide formulary and clinical edit SME support to Formulary and Benefit Management teams.
• Support clinical program evaluation across populations to improve disease outcomes and safety.
• Assist in development and analysis of clinical programs across lines of business.

Educación

Pharmacy degree (Pharm.D., MS)

Descripción del empleo

Centene Corporation is seeking a Pharmacist to define and develop standard and custom formularies for complex medications for assigned plans. The role involves developing clinical criteria, monitoring prior authorization requests, and designing clinical edits to adjudicate claims, while supporting clinical program initiatives and regulatory reporting.

Qualifications include a Pharm.D. or MS in pharmacy with 4+ years of pharmacy experience in mail order, retail, hospital, or managed care.