Clinical Formulary Pharmacist

🔥 0 minutes ago

🌵 Arizona, California – Remote

🌵 Arizona – Remote 🏄 California – Remote

💵 $107.7k - $199.3k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

💊 Pharmacist

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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

• Define and develop standard and custom formularies for all lines of business including Commercial, Medicaid, Medicare Part D and the Health Information Marketplace • Develop drug product review and formulary recommendations by assessing drug use trends, new drug releases and review of primary literature • Analyze pharmacy cost of care, trends, and coordinate the development of appropriate use protocols and guidelines • Set criteria for medication analysis, coordinate reports to clients, meet regulatory reporting requirements for drug utilization review and fraud and abuse reporting • Develop clinical criteria for review of non-formulary or non-preferred drug lists medications and communicate recommendations to clients • Develop and design clinical edits to adjudicate claims and enhance drug utilization • Develop and review guideline criteria for prior authorization and non-formulary drugs in support of Pharmacy and Therapeutics Committee function and pharmacy benefit design • Research drug information to maintain drug knowledge and disease state understanding for application to prior authorization reviews • Provide clinical guidance and support to the assigned pharmacy technicians • Provide support documentation and develop communication for the Pharmacy & Therapeutic (P&T) Committee review process and decisions • Performs other duties as assigned

🎯 Requirements

• 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

🏖️ 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