Position Purpose: Define and develop standard and custom formularies for assigned plan.
Develop clinical criteria for review of medications, recommend plan design changes and communicate recommendations to clients
Monitor and review prior authorization requests for medications
Develop and design clinical edits to adjudicate claims and enhance drug utilization
Analyze pharmacy cost of care, trends, and coordinate the development of appropriate use protocols and guidelines
Set criteria for medication analysis, coordinate reports to clients, meet regulatory reporting requirements for drug utilization review and fraud and abuse reporting
Research drug information to maintain drug knowledge and disease state understanding for application to prior authorization reviews
Participate in the development and implementation of medication therapy management programs
Provide clinical guidance and support to various departments and address clinical related questions
Education/Experience: Bachelor's degree or advanced degree (Pharm.D., M.S.) in pharmacy. 2 years of mail order, retail, hospital or managed care pharmacy experience or 1 years of pharmacy residency program experience.
Licenses/Certifications: Current state's Pharmacist license with no restrictions.
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.