Clinical Pharmacist
6 days ago
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.
- 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.
- 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.
- 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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