Pharmacy Coordinator – FWA

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🔥 0 minutes ago

🐊 Florida, Kansas, +3 more states – Remote

🐊 Florida – Remote 🌪️ Kansas – Remote 🌾 Nebraska – Remote 🗿 South Dakota – Remote 🎸 Tennessee – Remote

💵 $19 - $32 / hour

⏰ Full Time

🟡 Mid-level

🟠 Senior

💊 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

• Review and respond to fraud, waste, and abuse (FWA) referrals, inquiries, and requests from internal and external stakeholders • Support regulatory requests, reporting, and documentation related to FWA investigations and reviews • Research and help resolve concerns involving inappropriate billing, waste, and potential FWA activity • Communicate with members, providers, and pharmacies to gather information and support preliminary reviews • Generate and analyze reports to identify trends, support investigations, and assist with program oversight • Contribute to department process improvements and maintain accurate documentation • Support the pharmacy department's development, coordination, and maintenance of the health plan's pharmacy program • Receive and respond to provider and pharmacy calls regarding pharmacy benefits • Resolve complaints and grievances related to the pharmacy network in conjunction with the Pharmacy team • Assist departments in educating providers on the health plan’s pharmacy processes • Assist with the pharmacy utilization review and reporting process • Assist with member inquiries • Perform other assigned duties and activities • Comply with all policies and standards

🎯 Requirements

• 3+ years of pharmacy technician experience, preferably in a managed care environment • Experience in a dispensing pharmacy environment, such as retail, specialty, long-term care, or mail-order pharmacy • Medicare and/or Medicaid experience preferred • Strong attention to detail, analytical thinking, and organizational skills • Ability to collaborate effectively in a team-oriented environment while managing multiple priorities • Proficiency with Microsoft Office applications, including Word, Excel, PowerPoint, and Outlook • Excellent verbal and written communication skills with members, providers, pharmacies, and internal stakeholders • Interest in fraud, waste, and abuse prevention, compliance, and program integrity • High school diploma or equivalent • Prior experience using analysis tools or systems • Experience in implementing quality process improvement efforts • Experience documenting requirements, creating training materials, and working directly with end users • Current state's Pharmacy Technician license preferred • Availability Monday–Friday, 8:00 AM–4:30 PM Eastern or Central time

🏖️ Benefits

• Competitive pay • Health insurance • 401K plans • Stock purchase plans • Tuition reimbursement • Paid time off plus holidays • Flexible approach to work with remote, hybrid, field or office work schedules • Incentives may be included in total compensation