Clinical Pharmacist – Formulary, Quality

🔥 54 minutes ago

🇺🇸 United States – 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

• Define and develop standard and custom formularies for assigned plan • Lead formulary, prior authorization, and clinical policy initiatives • Support quality improvement and medication-related clinical programs • Analyze pharmacy and performance data • Develop policies, workflows, educational materials, and communications • Partner with cross-functional teams, providers, and vendors to implement state-driven and quality-focused initiatives • Develop clinical criteria for medications • Recommend plan design changes and clinical programs • Monitor prior authorization requests • Provide clinical support to internal departments and address clinical-related questions • Ensure appropriate quality controls and initiate opportunities for performance improvement in pharmacy/practice • Develop, implement, and maintain programs designed to impact DUR for Medicaid and Medicare • Develop, implement, and maintain pharmacy department policies and procedures • Participate in coordination of the Medicare MTM program • Assist the case management team, including clinical rounds presentations • Collaborate and provide cross-coverage across Formulary & Policy and Quality & Clinical Programs functions • Impact member access, medication safety, quality outcomes, and regulatory compliance within Indiana Medicaid pharmacy programs

🎯 Requirements

• Bachelor’s degree or advanced degree (Pharm.D., M.S.) in pharmacy • 2+ years of mail order, retail, hospital or managed care pharmacy experience OR 1+ years of pharmacy residency program experience • Current Indiana Pharmacist license with no restrictions • Specialty drug management experience, preferred • Experience in managed care, Medicaid, health plans, PBMs, formulary management, prior authorization, quality improvement, specialty drug management and/or population health • Strong clinical judgment • Strong written communication • Project management skills • Data analysis skills • Collaboration skills • Ability to manage competing priorities • Ability to translate complex requirements into actionable solutions • Ability to identify risks • Ability to consistently deliver accurate, audit-ready work • Ability to work Monday through Friday on a daytime Eastern Time schedule

🏖️ 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 employer committed to diversity