Clinical Pharmacist

🔥 12 hours ago

🐊 Florida – Remote

🐊 Florida – Remote

💵 $107.7k - $199.3k / year

⏰ Full Time

🟢 Junior

💊 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

• Process and review prior authorization requests for non-formulary medications for clinical appropriateness • Review completed prior authorization requests and pharmacy technician recommended denials, formulary alternatives, comments, and attachments • Verify member identification, date of birth, eligibility, carrier and group information • Check previous prior authorization decisions and verify prescription and health plan benefit coverage • Evaluate prescription claim history, chart notes, lab values, provider specialty, and medical policy criteria • Determine whether requests meet approval criteria using case-by-case professional clinical judgment • Review medication requests not addressed by P&T Committee criteria or guidelines and develop and draft criteria • Research and contribute drug references and clinical information for prior authorization review • Communicate with physicians and pharmacy technicians regarding non-formulary drugs, benefits, exclusions, quantity limits, age restrictions, and formulary alternatives • Retrieve, collect, and compile data for reporting purposes • Audit pharmacy claims greater than $200.00 • Suggest additions or deletions to the formulary and update quantity/day or age-limit entries • Support the National P&T Committee • Perform other related duties as needed

🎯 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 or Doctorate of Pharmacy degree • One year prior experience • Must have and maintain current, valid and unrestricted Pharmacist license in the state of employment • Must be credentialed by the health plan of employment • May be required to obtain additional state licensure based on business needs • Experience in managed care, utilization management, prior authorization, or health plan pharmacy operations is preferred • Participation in periodic weekend and holiday coverage rotations • Clinical pharmacy knowledge and professional clinical judgment • Ability to review chart notes, lab values, prescription claim history, benefits, and formulary criteria

🏖️ Benefits

• Competitive pay • Health insurance • 401K • 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 • Equal opportunity and diversity commitment