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.

This is a remote-HI position. The individual must reside in Hawaii and have a valid and active Hawaii Pharmacist license. There may be times that in-person meetings with providers, pharmacies, or the health plan will require the individual to meet in-person.

Position Purpose Provide timely drug therapy for Medicaid health plan members by processing prior authorization and medical necessity requests

• Review prior authorization 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 Medicare Part D 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
• Performs other duties as assigned
• Complies 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 Current state’s Pharmacist license with no restrictions. Additional license may be required as need by state or contract.

Preferred Qualifications

• Tech-savvy, good with using various technologies or ability to learn new ones
• Having previous health plan experience in Hawaii (understands HI heath plan rules)
• Understanding of Prior Authorization, Utilization Management, for both pharmacy and medical pharmacy
• Ability to handle pressure with being part of a small team and point person for many requests
  
  

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