Senior Clinical Pharmacist

4 days ago

New York, New York, United States Centene Corporation Full time

Transformative Role in Medical Management

You have the opportunity to revolutionize healthcare for 28 million members as a clinical professional on our Medical Management/Health Services team at Centene Corporation.

Position Purpose:

Develop and implement standard and custom formularies for complex or specialized medications, ensuring optimal patient outcomes and cost-effectiveness.

Key Responsibilities:

  1. Define and develop clinical criteria for review of complex or specialized medications, recommending plan design changes and communicating recommendations to clients.
  2. Monitor and review prior authorization requests for complex or specialized medications, ensuring adherence to established guidelines.
  3. Analyze pharmacy cost of care, trends, and coordinate the development of appropriate use protocols and guidelines.
  4. Set criteria for medication analysis, coordinate reports to clients, meet regulatory reporting requirements for drug utilization review and fraud and abuse reporting.
  5. Develop and implement medication therapy management programs, evaluating program performance, recommending changes, and ensuring successful implementation.
  6. Ensure and evaluate quality controls, implementing opportunities for performance improvement.
  7. Research drug information to maintain drug knowledge and disease state understanding for application to prior authorization reviews.
  8. Provide clinical guidance and support to various departments, addressing clinical-related questions.
  9. Define, develop, implement, and maintain standard and custom formularies and/or clinical edits, as required by your manager.

For Clinical Programs (Operational Excellence):

Support ongoing evaluation of clinical program initiatives promoting quality, safety, and cost of care opportunities.

Support oversight, development, and expansion of clinical pharmacy programs and initiatives by assessing utilization trends and relevant data and literature.

Analyze pharmacy data and trends needed to drive positive member outcomes.

Ensure and develop strategic relationships supporting organizational strategic initiatives.

Education/Experience:

Bachelor's degree or advanced degree (Pharm.D., M.S.) in pharmacy. 4+ years of mail order, retail, hospital, managed care pharmacy experience or pharmacy residency program experience.

Licenses/Certifications:

Current state's Pharmacist license with no restrictions. May be required to obtain additional state licensure based on business needs.

Compensation:

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's Commitment:

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.

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