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Clinical Pharmacy Specialist
2 months ago
We are seeking a highly skilled Clinical Pharmacist to join our Medical Management/Health Services team at Centene Corporation. As a Clinical Pharmacist, you will play a critical role in supporting our Medicare Pharmacy Stars Measures and providing specialized support for Medicare lines of business.
Key Responsibilities- Interact with vendors (PPGs) that support our Medicare Stars Pharmacy Performance
- Communicate with Providers and PPGs regarding Medicare Stars Pharmacy Performance
- Provide pharmacy and member communication supporting our Medicare members
- Work with Market Quality teams to collaborate on strategies and communicate with our external partners
- Communicate with Centene Pharmacy Services Pharmacy Quality team while working on Medicare Stars Pharmacy measures
- Answer formulary and benefits questions
- Support provider and member material creation or review
- Interact with internal Provider Engagement teams to drive impact for Medicare Pharmacy Stars measures
- Ensure timely and accurate submission of all HPMS formulary files, PA files, ST files, and other UM restrictions in accordance with CMS requirements
- Create, maintain, review, and approve ST files/documents for submission to HPMS
- Responsible for maintaining files to support monthly updates of formulary print and website documents, including Health Net Medicare Part D formularies, PA criteria, ST criteria, and Negative Formulary Changes
- Oversee Transition Program to ensure clinical and operational functionality is implemented to support an appropriate transition process for new enrollees prescribed Part D drugs that are not on the formulary
- Oversee Negative Formulary Change Process to ensure required notification and revisions of formulary documents and systems are complete
- Ensure HNPS compliance with CMS formulary requirements per the Medicare Prescription Drug Benefit Manual, Chapter 6 Part D Drugs and Formulary Requirements
- Provide guidance and clarification for Part B v. Part D coverage determinations
- Bachelor's or Doctorate of Pharmacy degree
- Two to four years of experience working within a pharmacy or related healthcare environment
- Minimum one year of pharmacy residency training completed (or equivalent training/experience) preferred
- Current, valid, and unrestricted Pharmacist license in the state of employment
- Competitive pay
- Health insurance
- 401K and stock purchase plans
- Tuition reimbursement
- Paid time off plus holidays
- A flexible approach to work with remote, hybrid, field, or office work schedules
