Centene Corp

Clinical Pharmacist

Centene Corp • $107K — $199K *
US-AnywhereRemote in Florida, US
Healthcare
Less than 5 years of experience
Job Overview by Ladders

Qualifications

  • Bachelor's or Doctorate of Pharmacy degree required.
  • Must have and maintain a valid Pharmacist license in the state of employment.
  • One year of prior experience in a related field is preferred.
  • Experience in managed care, utilization management, or health plan pharmacy operations is advantageous.
  • Availability for weekend and holiday coverage rotations as needed.

Responsibilities

  • Process prior authorization requests for non-formulary medications.
  • Verify member ID, eligibility, and coverage details.
  • Evaluate prescription claims and previous prior authorization decisions.
  • Apply Medical Policy Criteria to assess prior authorization requests.
  • Communicate effectively with physicians regarding prior authorizations and plan benefits.
  • Compile and report data related to drug utilization and formulary management.
  • Contribute drug references and clinical information for review.

Benefits

  • Comprehensive health insurance coverage.
  • 401K and stock purchase plans.
  • Tuition reimbursement for continued education.
  • Paid time off plus holidays.
  • Flexible work schedules including remote, hybrid, field, or office options.
Full Job Description
Position Purpose: The Clinical Pharmacist processes review prior authorization requests for non-formulary medications for clinical appropriateness. This assures members receive the most effective and cost effective pharmacological therapies.

Key Details: Must be authorized to work in the U.S. without the need for employment-based visa sponsorship now or in the future. Sponsorship and future sponsorship are not available for this opportunity, including employment-based visa types H-1B, L-1, O-1, H-1B1, F-1, J-1, OPT, or CPT.

Experience in managed care, utilization management, prior authorization, or health plan pharmacy operations is preferred. This role includes participation in periodic weekend and holiday coverage rotations to support business needs.

  • Reviews a completed prior authorization request received from the provider and/or reviews the pharmacy technician's recommended denial, suggested formulary alternatives, comments and attachments for appropriateness.
  • Verifies member's ID number and date of birth.
  • Verifies member's eligibility in the appropriate health plan eligibility system.
  • Records carrier and group number if applicable.
  • Checks for previous prior authorization decisions.
  • Verifies coverage in member's prescription benefit when necessary.
  • Verifies coverage in member's health plan benefit when necessary.
  • Evaluates prescription claim history.
  • Reviews chart notes and/or lab values.
  • Identifies provider specialty when appropriate.
  • Applies Medical Policy Criteria to prior authorization requests.
  • Evaluates whether request meets criteria for approval.
  • Reviews the request using professional clinical judgment on a case by case basis. A pharmacist will review medication requests not addressed by P&T Committee criteria or guidelines, develop and draft criteria for the non-formulary medication requested.
  • Researches and contributes drug references and clinical information to facilitate prior authorization review: directly to physicians via fax or phone encounter; or to pharmacy technicians via memo or on a personal level as an educational tool
  • Communicates with physicians regarding prior authorization:
    • For a non-formulary drug
    • Plan benefits, exclusions
    • Quantity limits
    • Age restrictions
    • Formulary alternatives
  • Retrieves and collects data through available reporting resources (i.e. Discoverer, IT Department)
  • Compiles data for reporting purposes:
    • Drug utilization of non-formulary drugs
    • Overturned IPS recommended denials
    • Audit pharmacy claims greater than $200.00
    • Suggest addition or deletion of drugs to/from the formulary
    • Updating qty/days or age limit ends
    • Support National P&T Committee
    • Other tasks which may arise during the performance of any of the above mentioned duties


Education/Experience: Bachelor's or Doctorate of Pharmacy degree.
One year prior experience.

License/Certification: Must have and maintain current, valid and unrestricted Pharmacist license in the state of employment and credentialed by the health plan of employment.

May be required to obtain additional state licensure based on business needs

Pay Range: $107,700.00 - $199,300.00 per year

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, including full-time or part-time status. Total compensation may also include additional forms of incentives. Benefits may be subject to program eligibility.

About Centene Corp

Centene Corporation is a managed healthcare enterprise at the forefront of innovation and growth for government-sponsored and commercial healthcare, providing access to fully integrated, high-quality, and cost-effective services that help people lead healthier lives. The company’s local approach addresses the needs of under-insured and uninsured individuals who often lack the resources required to sustain optimal health and wellness. Centene began as a single health plan in Milwaukee, Wisconsin in 1984. After an initial period of growth, Michael Neidorff joined as President and Chief Executive Officer (CEO) in 1996, moving Centene’s headquarters to St. Louis, Missouri, where it still resides today. In the decades since its humble beginnings, Centene has transformed into a publicly-traded Fortune 500 company serving communities across the United States. In fact, Centene provides coverage in all 50 U.S. states. More than 26 million Americans rely on Centene to access a wide range of insurance solutions, including Medicaid, Medicare, TRICARE, correctional, and behavioral health services. Centene prioritizes the development of technology that addresses systemic conditions impacting the whole health needs of underserved populations. As technology plays an increasingly critical role in diagnosing, managing, and treating disease, Centene understands that it enables better health outcomes for members, lessening the burden for providers, and allowing more automation and efficiency for business operations. As a steward of a significant set of data and insights, Centene leverages this data to not only shape but lead the digital transformation of healthcare and improve the patient-provider experience. Centene’s current CEO, Sarah London, and her team are leading the charge in this new age. Sarah London worked within Centene’s Technology Innovation and Modernization division, spearheading the company’s enterprise-wide technology strategy. Now leading Centene, her focus is on building the next generation of products and services and establishing Centene’s long-term growth and value creation. Although Centene has grown into the No. 1 insurer in the U.S. Health Insurance Marketplace, it has never lost its focus on the individual or its passion for community health. Remaining connected to the individuals and families that need care most is central to Centene’s commitment to shaping a better world of healthcare for the communities it serves. Centene also remains connected to the needs of its employees, who make Centene what it is. Through its commitment to diversity, equity, and inclusion practices, Centene promotes a safe and inviting environment above all. Because of Centene’s commitment to excellence and progression in the healthcare industry, it has been recognized as a Top Organization for Diversity by Modern Healthcare magazine, a Leading Disability Employer by the National Organization on Disability, a Best Place to Work for LGBTQ Equality by The Human Rights Campaign Foundation, and a global leader by Bloomberg’s Gender-Equality Index, among many other recognitions. Centene was also named a Top 50 Company for Diversity by DiversityInc and a Top Veteran-Friendly Company by U.S. Veterans Magazine. It has also been listed on FORTUNE® magazine's list of the World's Most Admired Companies for several consecutive years.

Centene Corp Careers

Join the dynamic team at Centene Corp, a leader in the healthcare industry, where your career growth and development are prioritized. At Centene Corp, we offer a range of job opportunities that allow you to make a significant impact on our community and beyond.

Explore a World of Opportunities

Discover the diverse career paths available at Centene Corp, from healthcare services to innovative program development. Our job opportunities span various professional fields, offering positions that cater to your unique skills and ambitions. Whether you're looking for an entry-level role or a senior leadership position, Centene Corp is committed to hiring top talent and fostering a culture of excellence.

Innovation and Leadership at Centene Corp

At Centene Corp, innovation and leadership go hand in hand. We empower our team members to lead with confidence and creativity, driving the company forward through strategic innovation and robust leadership. Our leadership programs are designed to cultivate your skills, helping you to thrive as a professional and make meaningful contributions to our company and the communities we serve.

Internships and Early Career Programs

Kickstart your career with Centene Corp through our internship and early career programs. These opportunities provide hands-on experience and a glimpse into the dynamic world of healthcare management. Internships at Centene Corp are a stepping stone to full-time employment, offering invaluable networking opportunities, mentorship, and the chance to develop your resume and interview skills in a real-world setting.

Commitment to Diversity and Inclusive Culture

Centene Corp is dedicated to maintaining a diverse and inclusive work environment. We believe that diversity fuels innovation and enhances our team's performance. Our diversity training ensures that all team members appreciate and leverage the broad range of experiences and perspectives that each individual brings to the company.

Benefits and Employee Growth

We value our employees' well-being and career aspirations. Centene Corp offers competitive benefits, including health insurance, retirement plans, and professional development programs. Our commitment to your growth is reflected in our continuous learning initiatives and performance management processes that help you achieve your career goals.

Join Our Team

Are you ready to advance your career at Centene Corp? Explore our current job openings and find the position that best matches your skills and interests. We are looking for passionate, curious, and solution-driven team players who are ready to make a difference.

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SEARCH CENTENE JOBS

Centene Corp is not just a company—it's a place where you can shape your future and impact the lives of millions. Join us in our mission to transform the health of the community, one person at a time.
Learn more about Centene Corp
Size
72,500 employees
Market Cap
$46.5 billion
Industry
Net Income
$1.8 billion
Founded
1984
5 Year Trend
+25.4%
Revenue
$111.1 billion
NASDAQ

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