Manager, Clinical Pharmacy Operations

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🏄 California – Remote

🏄 California – Remote

💵 $107.7k - $199.3k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

⚙️ Operations

👻 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

• Develop, implement, and administer clinical pharmacy tools and programs supporting corporate and regional drug utilization and financial goals • Direct and manage clinical pharmacy activities through subordinate staff • Enhance pharmaceutical care quality and promote cost-effective utilization for members • Develop, implement, and maintain clinical quality assurance, formulary management, drug utilization review, compliance, and education programs • Coordinate clinical efforts with other departments to implement cohesive programs • Monitor staff quality assurance and validate compliance with regulatory standards, including Medicare Star ratings and HEDIS measures • Oversee and/or develop clinical recommendations and guidelines for Pharmacy and Therapeutics committee approval • Monitor clinical advancements and evidence-based pharmacy practice changes • Oversee compliant administration of the pharmacy benefit • Serve as clinical pharmacy liaison to outside agencies and providers • Act as primary contact for clinical pharmacy issues in the assigned area • Perform other duties as assigned • Comply with all policies and standards

🎯 Requirements

• Doctor of Pharmacy degree from an accredited school • One to three years clinical pharmacy experience including formulary development, drug utilization review, and/or medication therapy management • Four years progressively responsible positions within managed care pharmacy • Minimum of two years in a management role • Public speaking experience • Must have and maintain current, valid and unrestricted state Registered Pharmacist License for assigned region(s) • Experience with managed care or PBM clinical pharmacy operations, including clinical edits, drug utilization review, prior authorization, claims adjudication, or formulary management • Experience working with Medicaid requirements, pharmacy claims standards, PBM partners, and cross-functional teams strongly preferred • People leadership experience

🏖️ 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

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