[Hiring] Manager, Clinical Pharmacy Operations @Centene Corporation

Role Description

The Manager of Clinical Pharmacy Operations is responsible for developing, implementing and administering clinical pharmacy tools and programs to support corporate and regional drug utilization and financial goals.

• This position is fully remote.
• The ideal candidate will have:
  • People leadership experience
  • A strong background in managed care or PBM clinical pharmacy operations, including:
    • Clinical edits
    • Drug utilization review
    • Prior authorization
    • Claims adjudication
    • Formulary management
  • Experience working with Medicaid requirements, pharmacy claims standards, PBM partners, and cross-functional teams (strongly preferred)
• Directs and manages clinical pharmacy activities through subordinate staff to enhance the quality of pharmaceutical care and promote cost-effective utilization of pharmaceuticals for members.
• Responsible for the development, implementation and ongoing maintenance of clinical pharmacy programs including but not limited to:
  • Clinical quality assurance programs
  • Formulary management
  • Drug utilization review
  • Compliance and/or education
• Coordinates clinical efforts with other department functional areas to ensure implementation of cohesive programs.
• Performs quality assurance monitoring of staff to ensure best practices are met and validates that clinical pharmacy programs meet applicable regulatory and compliance standards, such as:
  • Medicare Star ratings
  • HCQA HEDIS measures
  • Regulations
• Oversees and/or develops clinical recommendations and guidelines for approval by the Pharmacy and Therapeutics committee.
• Monitors clinical advancements and changes in evidence-based pharmacy practice to ensure appropriate coverage of the most safe and effective pharmaceuticals and/or implementation of effective programs.
• Oversees compliant administration of the pharmacy benefit.
• Acts as clinical pharmacy liaison to outside agencies and providers as well as the primary point of contact for responsible area on clinical pharmacy issues as needed.
• Performs other duties as assigned.
• Complies with all policies and standards.

Qualifications

• Doctor of Pharmacy degree from an accredited school.
• One to three years clinical pharmacy experience including:
  • Formulary development
  • Drug utilization review
  • Medication therapy management
• Four years progressively responsible positions within managed care pharmacy with a minimum of two years in a management role.
• Public speaking experience.

Requirements

• Must have and maintain current, valid and unrestricted state Registered Pharmacist License for assigned region(s).

Benefits

• Competitive pay
• Health insurance
• 401K and stock purchase plans
• Tuition reimbursement
• Paid time off plus holidays
• Flexible approach to work with remote, hybrid, field or office work schedules