You could be the one who changes everything for our 28 million members as a clinical professional on our Medical Management/Health Services team. Centene is a diversified, national organization offering competitive benefits including a fresh perspective on workplace flexibility.
Clinical Pharmacist - Florida Medicaid
Position Purpose: Provide timely drug therapy for Medicaid health plan members by processing grievances/appeals, medical necessity requests and clinical programs.
- Review grievances/appeals requests and make determinations for drug products according to member benefits and coverage criteria.
- Responsible for setting criteria for medication analysis, coordinate reports to clients, meet regulatory reporting requirements for drug utilization review and fraud and abuse reporting.
- Develop clinical criteria for review of non-formulary or non-preferred drug lists medications and communicate recommendations to clients.
- Oversee the drug utilization review and medication therapy management programs at the assigned plan to meet state requirements and develop systematic reviews of prescription claims to meet strategic initiatives.
- Develop clinical edits effective at the point of sale to enhance appropriate drug utilization based on evidence-based criteria.
- Provide clinical guidance and support to the assigned pharmacy technicians.
- Develop and review guideline criteria for prior authorization and non-formulary drugs in support of Pharmacy and Therapeutics Committee function and pharmacy benefit design.
- Ensure and evaluate quality controls and implement opportunities for performance improvement in pharmacy practices.
- Research drug information to maintain drug knowledge and disease state understanding for application to prior authorization reviews.
- Perform other duties as assigned.
- Comply with all policies and standards.
Education/Experience: Bachelor’s degree or advanced degree (PharmD., M.S) in pharmacy. 3+ years of retail or hospital pharmacy experience or 1+ years of managed care pharmacy experience. Clinical pharmacy experience in managed healthcare preferred.
License/Certification: Florida state Pharmacist license with no restrictions. Additional license may be required as needed by state or contract.
Working Shift: 10am - 6:30pm (EST) with every other weekend / Saturday & Sunday from 8am - 4:30pm (EST). Will maintain 5 days per week; on your weekend you have one day off during the week before and one day off during the week after.
*To be considered, you must live in Florida and be a Florida Licensed Pharmacist.
Pay Range: $103,500.00 - $191,600.00 per year.
Centene offers a comprehensive benefits package including: competitive pay, health insurance, 401K and stock purchase plans, tuition reimbursement, paid time off plus holidays, and a flexible approach to work with remote, hybrid, field or office work schedules. Actual pay will be adjusted based on an individual's skills, experience, education, and other job-related factors permitted by law. Total compensation may also include additional forms of incentives.
Centene is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law.
Qualified applicants with arrest or conviction records will be considered in accordance with the LA County Ordinance and the California Fair Chance Act.
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