Medical Staff Services Coordinator
3 weeks ago
You could be the one who changes everything for our 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.
Position Purpose: Perform duties to support the efforts of the 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 plans pharmacy process.
- Assist with the pharmacy utilization review and reporting process.
- Collaborate with Quality Improvement department with various meeting preparation and transcription of minutes.
- Comply with all policies and standards.
**3+ years of pharmacy experience, preferably in a managed care environment. 73 per hour
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.
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.
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