You could be the one who changes everything for our 28 million members. Centene is transforming the health of our communities, one person at a time. As a diversified, national organization, you’ll have access to competitive benefits including a fresh perspective on workplace flexibility.
Clinical Account Manager - Pharmacist (EST / CST)
Job Specific Details:
Managing the clinical aspects for 2-3 health plans including but not limited to
Formular Management
Benefit management
Providing Clinical Reports
Communicating with health plan assigned pharmacy teams daily
Conducting weekly operational calls with the markets to align on open items and projects
Interface with internal and external teams including state regulators in order to complete contractual obligations for the assigned plans
Desired Skills / Experience:
Clinical expertise with formulary and benefit management
All Microsoft products including copilot
Familiar with the process of submitting tickets on a customer platform such as ServiceNow
Having an eye for detail and reading trends in large reports and files
Ability to stay focused on top of tasks and provide quick responses and complete follow-up to inquiries as appropriate
Present in virtual or in person formats
Handle multiple tasks and competing priorities at the same time and addressing them methodically and successfully
Being able to work with different personalities and work styles in order to adapt to our health plan leaders needs
Working Shift: 8am - 5pm (EST) or (CST)
Position Purpose: Provide clinical expertise to clients in designing benefits/clinical programs to optimize therapeutic outcomes while maintaining economic efficiency in the delivery of medication therapy. Interface with external clients and marketing staff to facilitate the development of clinical products that maximize cost effective medication benefits.
Provide expertise in benefit design planning methods and strategies
Provide clinical expertise to clients, explain clinical programs, and communicate new practice or clinical information to clients
Develop and present performance reviews in conjunction with client account team
Perform clinical data and drug utilization review analysis to meet client requirements and requests
Collaborate with Clinical Pharmacists to enhance drug utilization review program and prior authorization review process and assist with related activities
Provide input into the Request for Proposal process and work with Marketing and Sales to facilitate timely response and data analysis
Ensure that client clinical needs are met, including formulary management, benefit design, drug utilization review and clinical programs
Participate in the development and management of customized clinical business plans appropriate for each client, including the evaluation of current client program and restrictions (prior authorization, quantity limits, age limits) to determine appropriate utilization of drug therapy
Consult with clients to develop and implement appropriate clinical interventions and claim adjudication edits.
Participate in the development of disease state management modules by interfacing with company partners to improve array of marketable products
Performs other duties as assigned
Comply with all policies and standards
Education/Experience: Bachelor’s degree or advanced degree (PharmD., M.S) in pharmacy. 3+ years of retail or hospital pharmacy experience or 1+ years of managed care pharmacy experience. Clinical pharmacy experience in managed healthcare preferred. Centene Pharmacy Services: 3+ years managed care pharmacy or pharmacy benefit management experience preferred.
License/Certification: Current state’s pharmacist license with no restrictions.
Pay Range: $107,700.00 - $199,300.00 per yearCentene 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. Actual pay will be adjusted based on an individual's skills, experience, education, and other job-related factors permitted by law, including full-time or part-time status. Total compensation may also include additional forms of incentives. Benefits may be subject to program eligibility.
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
