Description
Position Purpose: Perform duties to support the efforts pharmacy department in the development, coordination and maintenance of the health plan's pharmacy program.
Receive and respond to provider and pharmacy calls regarding the prior authorization and formulary process
Perform review of pharmacy and override process in compliance with pharmaceutical related company and State guidelines
Track and trend overrides to ensure criteria have been met, audit for prior authorizations, analyze cost and determine utilization patterns
Resolve complaints and grievances related to the pharmacy network in conjunction with the Pharmacy team
Assist Provider Relations and various departments with educating providers on the health plan's pharmacy process
Assist with the pharmacy utilization review and reporting process
Collaborate with Quality Improvement department with various meeting preparation and transcription of minutes
Assist with members' inquiries related to the formulary process
Education/Experience: High school diploma or equivalent. 3+ years of pharmacy experience, preferably in a managed care environment. Medicare and/or Medicaid experience preferred.
For Superior Health Plan:
Education/Experience: High school diploma or equivalent. 3+ years of pharmacy experience, preferably in a managed care environment. Medicare and/or Medicaid experience preferred. Previous experience in call center or fast paced pharmacy answering multi-line phone system preferred. Microsoft office experience preferred (Excel, Word, PowerPoint)
License/Certificate: Current state's Pharmacy Technician license and Pharmacy Technician Certification Board (PTCB) or the ability to obtain both license and PTCB within 30 days of the start date.
For Arizona Complete Health:
Education/Experience: High school diploma or equivalent. 3+ years of pharmacy experience, preferably in a managed care environment. Medicare and/or Medicaid experience preferred.
License/Certificate: Current Arizona Pharmacy Technician license.
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.
