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Position Title: Clinical Pharmacist 1
Work Location: Remote (Preferred NC, AZ, KS, TX, IN, GA, NJ, CA, FL)
Assignment Duration: 6 months possible extension (temp to permanent)
Work Schedule: 8 hour shift (typically 9-530pm in worker's timezone) Position Summary:
- Purpose: Primary duty for this position is to review prior authorization requests for medical benefit (buy and bill) drugs requests across the Medicare, Medicaid, Exchange, and Commercial lines of business
- This position is fully remote. We prefer a candidate with strong clinical skills, drug knowledge, and managed care experience in prior authorization review. We expect a candidate that embodies Centene culture.
- : Setting clear goals, being transparent about outcomes, and inviting feedback to foster growth.
- : Pushing past fear and uncertainty to make the best possible decisions.
- : Approaching every interaction as an opportunity to learn.
- : Demonstrating integrity, honesty, and vulnerability to build strong relationships.
- : Focusing our work through the lens of our mission.*Our department receives and reviews prior authorization requests for medical benefit (buy and bill) drugs requests across the Medicare, Medicaid, Exchange, and Commercial lines of business
*They will be required to review the doctor's request based on defined criteria to determine if the medication can be approved or denied.
*The RFS production goal is 90%. This goal should be met daily and monthly. This goal roughly averages to 47 cases completed per day.
The quality goal is 99.9%.
Years of experience required: 1+ years of retail, hospital, managed care, or PBM experience. Previous experience with reviewing prior authorizations for a managed care organization/PBM.
| Candidate Requirements |
| Required: Bachelor's or Doctorate of Pharmacy degree. |
Preferred: |
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| Required: Current state's Pharmacist license with no restrictions. |
Preferred: Pharmacist Licenses we required based on business needs:
- NC
- AZ
- KS
- TX
- IN
- GA
- NJ
- CA
- FL
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