Clinical Pharmacist – Quality

🔥 1 minute ago

🌽 Illinois, Iowa, +5 more states – Remote

🌽 Illinois – Remote 🌾 Iowa – Remote 🐎 Kentucky – Remote 🏈 Ohio – Remote 🚗 Michigan – Remote 🏰 Missouri – Remote 🧀 Wisconsin – Remote

💵 $107.7k - $199.3k / year

⏰ Full Time

🟢 Junior

💊 Pharmacist

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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 • 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 and implement 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 with members, including clinical rounds presentations • Contact providers regarding quality measures • Ensure clinical criteria align with state guidelines • Apply evidence-based findings to coverage policies and formulary decisions

🎯 Requirements

• Bachelor’s degree or advanced degree (Pharm.D., M.S.) in pharmacy • 2+ years of experience in managed care, clinical, hospital or retail pharmacy experience OR 1+ years of pharmacy residency program experience • Current state’s Pharmacist license with no restrictions • Strong data analysis skills • Microsoft Excel skills • Ability to critically evaluate clinical trials, treatment guidelines, and drug literature • Background in clinical pharmacy, managed care, and/or hospital preferred • Illinois Pharmacist license preferred but not required

🏖️ 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 • Equal opportunity employer committed to diversity