Clinical Account Manager

Job not on LinkedIn

🔥 0 minutes ago

🏰 Missouri – Remote

🏰 Missouri – Remote

💵 $107.7k - $199.3k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

💰 Account Manager

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Centene Corporation

WebsiteLinkedInAll Job Openings

10,000+ employees

Founded 1984

🛡️ Insurance

💼 Consulting

🏥 Healthcare

Insurance • Consulting • Healthcare

Centene Corporation is a leading provider of government-sponsored healthcare services, specializing in delivering affordable and high-quality healthcare solutions. For over 40 years, Centene has focused on transforming the health of communities by expanding access to Medicaid, Medicare, and Health Insurance Marketplace services, as well as serving military communities through the TRICARE program. As the largest Medicaid managed care organization and a key participant in the Marketplace, Centene emphasizes localized healthcare delivery combined with strong partnerships with nonprofit organizations to meet the unique needs of its members. Centene is also committed to corporate sustainability and social responsibility, prioritizing environmental stewardship and ethical governance to enhance the well-being of the communities it serves.

📋 Description

• Provide clinical expertise to clients in designing benefits and clinical programs to optimize therapeutic outcomes while maintaining economic efficiency • Interface with external clients and marketing staff to develop clinical products that maximize cost-effective medication benefits • Explain clinical programs and communicate new practice or clinical information to clients • Develop and present performance reviews with the client account team • Perform clinical data and drug utilization review analysis • Collaborate with Clinical Pharmacists to enhance drug utilization review and prior authorization review processes • Provide input into Requests for Proposal and work with Marketing and Sales on timely responses and data analysis • Ensure client clinical needs are met, including formulary management, benefit design, drug utilization review, and clinical programs • Develop and manage customized clinical business plans for each client • Consult with clients to develop and implement clinical interventions and claim adjudication edits • Participate in developing disease state management modules with company partners • Perform other duties as assigned and comply with policies and standards

🎯 Requirements

• Bachelor’s degree • Licensed qualification in pharmacy (PharmD., RPh.) • Current state’s pharmacy license with no restrictions • 3+ years of experience in Clinical pharmacy operations or case management experience in specialty pharmacy preferred • Direct experience interfacing with payers and/or manufacturers preferred • Ability to provide clinical expertise in benefit design planning methods and strategies • Ability to perform clinical data and drug utilization review analysis • Experience with formulary management, benefit design, drug utilization review, prior authorization, quantity limits, and age limits

🏖️ Benefits

• Competitive pay • Health insurance • 401K plan • Stock purchase plans • Tuition reimbursement • Paid time off plus holidays • Flexible approach to work with remote, hybrid, field or office work schedules • Additional forms of incentives may be included in total compensation