Clinical Audit Coordinator, Pharmacy

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🔥 0 minutes ago

🌵 Arizona, Florida, +2 more states – Remote

🌵 Arizona – Remote 🐊 Florida – Remote 🚗 Michigan – Remote 🤠 Texas – Remote

💵 $23 - $39 / hour

⏰ Full Time

🟢 Junior

🟡 Mid-level

💊 Pharmacist

🚫👨‍🎓 No degree required

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Centene Corporation

WebsiteLinkedInAll Job Openings

10,000+ employees

Founded 1984

⚕️ Healthcare Insurance

🤝 Non-profit

🌍 Social Impact

Healthcare Insurance • Non-profit • Social Impact

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

• Audit prior authorization activities • Identify opportunities for process improvement • Support clinical training initiatives • Help maintain the integrity of critical pharmacy systems and data • Partner with business groups to identify and resolve errors in data and reporting • Assist with the administration of audit processes and tools related to prior authorizations, appeals, quality improvement, star measurement reviews, inter-rater reliability and data entry • Assess training needs and identify, select or develop appropriate training programs including training aids and materials • Assist with training staff in the use of audit tools and identification of patterns or trends that require additional training or corrective action • Maintain records of training activities and employee progress • Participate in Quality and Advisory committees or provider education meetings

🎯 Requirements

• Pharmacy technician (CPhT) with experience working with Compass, TruCare, or CareCentral • Quality assurance on MedPharm (TruCare, ComPass and CareCentral) prior authorization requests • Clinical understanding of Medicare, Medicaid, Exchange and Commercial plans is a plus • Microsoft Excel & Access • 2+ years of pharmacy technician experience in a managed care or healthcare setting • Audit experience preferred • Current State’s licensure or Certified Pharmacy Technician (CPhT), preferred

🏖️ Benefits

• Competitive pay • Health insurance • 401K and stock purchase plans • Tuition reimbursement • Paid time off plus holidays • Flexible approach to work with remote, hybrid, field or office work schedules