Clinical Pharmacist – Quality
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Job Description
Remote Clinical Pharmacist developing formularies, clinical policies, and quality programs for Centene’s healthcare plans. Supporting prior authorization, DUR, Medicare MTM, and evidence-based coverage decisions.
Responsibilities:
- Define and develop standard and custom formularies for assigned plan
- Develop clinical criteria for medications
- Recommend plan design changes and clinical programs
- Monitor prior authorization requests
- Provide clinical support to internal departments and address clinical-related questions
- Ensure appropriate quality controls and initiate opportunities for performance improvement in pharmacy/practice
- Develop and implement programs designed to impact DUR for Medicaid and Medicare
- Develop, implement, and maintain pharmacy department policies and procedures
- Participate in coordination of the Medicare MTM program
- Assist the case management team with members, including clinical rounds presentations
- Contact providers regarding quality measures
- Ensure clinical criteria align with state guidelines
- Apply evidence-based findings to coverage policies and formulary decisions
Requirements:
- Bachelor’s degree or advanced degree (Pharm.D., M.S.) in pharmacy
- 2+ years of experience in managed care, clinical, hospital or retail pharmacy experience OR 1+ years of pharmacy residency program experience
- Current state’s Pharmacist license with no restrictions
- Strong data analysis skills
- Microsoft Excel skills
- Ability to critically evaluate clinical trials, treatment guidelines, and drug literature
- Background in clinical pharmacy, managed care, and/or hospital preferred
- Illinois Pharmacist license preferred but not required
Benefits:
- Competitive pay
- Health insurance
- 401K plan
- Stock purchase plans
- Tuition reimbursement
- Paid time off plus holidays
- Flexible approach to work with remote, hybrid, field or office work schedules
- Additional forms of incentives may be included in total compensation
- Equal opportunity employer committed to diversity
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