Clinical Pharmacist

6 days ago


Sacramento, California, United States Centene Corporation Full time
Job Summary

We are seeking a highly skilled Clinical Pharmacist to join our Medical Management/Health Services team. 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
  • Support Medicare Pharmacy Stars Measures by providing clinical pharmacy operations expertise.
  • Interact with vendors (PPG's) that support our Medicare Stars Pharmacy Performance.
  • Communicate with Providers and PPG's regarding Medicare Stars Pharmacy Performance.
  • Pharmacy and member communication supporting our Medicare members.
  • Work with Market Quality teams to collaborate on strategies and communicate with 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.
Additional Responsibilities
  • 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.
  • Maintain 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.
Requirements
  • 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.
  • Must have and maintain a current, valid, and unrestricted Pharmacist license in the state of employment.
What We Offer
  • 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.

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