Pharmacy Coordinator II

You could be the one who changes everything for our 28 million members as a clinical professional on our Medical Management/Health Services team. Centene is a diversified, national organization offering competitive benefits including a fresh perspective on workplace flexibility.
 

**This is a remote position open to candidates in PST or MST time zone**

Job Description:

Position Purpose: Perform duties to support the efforts pharmacy department in the development, coordination, and maintenance of the health plan's pharmacy program. Provides support for escalated issues and special projects as assigned.

• Receive and respond to provider, member, 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 override 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.
• Assist with the training and retention of employees.
• Assist with process improvements as needed.
• Performs other duties as assigned.
• Complies with all policies and standards.

Education/Experience: High School Diploma or equivalent required

5+ years of pharmacy experience required.

1+ years of managed care experience required.

Medicare and/or Medicaid experience preferred.

Centene offers a comprehensive benefits package including: competitive pay, health insurance, 401K and stock purchase plans, tuition reimbursement, paid time off plus holidays, and a flexible approach to work with remote, hybrid, field or office work schedules.  Actual pay will be adjusted based on an individual's skills, experience, education, and other job-related factors permitted by law.  Total compensation may also include additional forms of incentives.

Centene is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law.

Qualified applicants with arrest or conviction records will be considered in accordance with the LA County Ordinance and the California Fair Chance Act