Clinical Formulary Pharmacist

🔥 0 minutes ago

🐊 Florida – Remote

🐊 Florida – Remote

💵 $107.7k - $199.3k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

💊 Pharmacist

👻 Ghost score 0%

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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

• Define and develop standard and custom formularies for Commercial, Medicaid, Medicare Part D, and Health Information Marketplace lines of business • Develop drug product reviews and formulary recommendations by assessing drug use trends, new drug releases, and primary literature • Analyze pharmacy cost of care and trends, and coordinate appropriate-use protocols and guidelines • Set criteria for medication analysis and coordinate client reports • Meet regulatory reporting requirements for drug utilization review and fraud and abuse reporting • Develop clinical criteria for non-formulary or non-preferred drug list medications and communicate recommendations to clients • Develop and design clinical edits to adjudicate claims and enhance drug utilization • Develop and review prior authorization and non-formulary guideline criteria supporting Pharmacy and Therapeutics Committee functions and pharmacy benefit design • Research drug information for prior authorization reviews • Provide clinical guidance and support to assigned pharmacy technicians • Prepare support documentation and communications for Pharmacy & Therapeutics Committee reviews and decisions • Perform other duties as assigned • Comply with all policies and standards

🎯 Requirements

• Must be authorized to work in the U.S. without the need for employment-based visa sponsorship now or in the future • Bachelor’s degree or advanced degree (PharmD., M.S) in pharmacy • 3+ years of combined managed care pharmacy or pharmacy residency program experience • Current state’s Pharmacist license with no restrictions • Knowledge of drug use trends, new drug releases, primary literature, pharmacy cost of care, and drug utilization review • Ability to develop clinical criteria, prior authorization guidelines, formulary recommendations, clinical edits, and medication-use protocols • Ability to research drug information and maintain drug knowledge and disease state understanding • Ability to provide clinical guidance to pharmacy technicians • Ability to support Pharmacy & Therapeutic Committee review processes

🏖️ 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 • Benefits may be subject to program eligibility