Pharmacy Operations Specialist II

🔥 0 minutes ago

🏈 Alabama, Arizona, +37 more states – Remote

🏈 Alabama – Remote 🌵 Arizona – Remote 🦌 Connecticut – Remote 🏛️ District of Columbia – Remote 🐊 Florida – Remote 🥔 Idaho – Remote 🌽 Illinois – Remote 🌾 Iowa – Remote 🌪️ Kansas – Remote 🐎 Kentucky – Remote ⚜️ Louisiana – Remote 🦞 Maine – Remote 🦬 Montana – Remote 🌾 Nebraska – Remote 🗻 New Hampshire – Remote 🏖️ New Jersey – Remote 🌶️ New Mexico – Remote 🌲 North Carolina – Remote 🌾 North Dakota – Remote 🏈 Ohio – Remote 🌪️ Oklahoma – Remote 🦀 Maryland – Remote 🍂 Massachusetts – Remote 🚗 Michigan – Remote ❄️ Minnesota – Remote 🎸 Mississippi – Remote 🏰 Missouri – Remote 🔔 Pennsylvania – Remote ⚓ Rhode Island – Remote 🌴 South Carolina – Remote 🗿 South Dakota – Remote 🎸 Tennessee – Remote 🤠 Texas – Remote ⛷️ Utah – Remote 🍁 Vermont – Remote ⚔️ Virginia – Remote ⛰️ West Virginia – Remote 🧀 Wisconsin – Remote 🦬 Wyoming – Remote

💵 $56.2k - $101k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

⚙️ Operations

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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

• Ensure administration of the pharmacy program is accurate and compliant • Support pharmacy operations tasks involving claims, formulary, benefit, and networks • Support PBM oversight and internal activities related to pharmacy fraud, waste, and abuse (FWA) • Support pharmacy audit functions • Join PBM operational calls and follow up on open items and resolutions • Implement and maintain accurate and compliant member and provider communication processes • Partner with internal teams, health plans, and PBM partners on communications, regulatory reporting, operational metrics, and pharmacy network activities • Support issue resolution, documentation updates, and process improvement initiatives • Conduct data analysis to support operations • Provide support for escalated issues and special projects • Conduct UAT to ensure systems reflect accurate information • Serve as subject matter expert for pharmacy operations tasks and pharmacy documents • Perform other duties as assigned • Comply with all policies and standards

🎯 Requirements

• Highschool Diploma or GED • 4+ years of pharmacy experience • 1+ year of managed care experience • Managed care experience working with pharmacy claims or PBM data • Ability to conduct data analysis to support operations and exercise independent judgement • Ability to manage multiple priorities independently • Strong attention to detail • Excellent organizational and communication skills • Advanced Excel skills • Experience with tools such as Power BI and/or Power Automate would be beneficial • Strong data analysis skills • Government sponsored program (Medicare and/or Medicaid) experience preferred • Bachelor’s degree preferred • Current state’s Pharmacy Technician license preferred

🏖️ 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