You could be the one who changes everything for our 28 million members as a clinical professional on our Medical Management/Health Services team. Centene is a diversified, national organization offering competitive benefits including a fresh perspective on workplace flexibility.
 

Position Purpose: Support Medicare Pharmacy Stars Measures.   Provides specialized support for Medicare lines of business as it applies to clinical pharmacy operations for Medicare Part D.

• Interaction with vendors (PPG’s) that support our Medicare Stars Pharmacy Performance
• Communication with Providers and PPG’s regarding Medicare Stars Pharmacy Performance
• Pharmacy and member communication supporting our Medicare members
• Working with Market Quality teams to collaborate on strategies and communicate with our external partners
• Communicating with Centene Pharmacy Services Pharmacy Quality team while working on Medicare Stars Pharmacy measures
• Answering formulary and benefits questions
• Supporting provider and member material creation or review
• Interacting with internal Provider Engagement teams to drive impact for Medicare Pharmacy Stars measures
• Ensures timely and accurate submission of all HPMS formulary files, PA files, ST files and other UM restrictions in accordance with CMS requirements.
• Creates, maintains, reviews and approves ST files/documents for submission to HPMS.
• Responsible for maintaining 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.
• Oversees 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.
• Oversees Negative Formulary Change Process to ensure required notification and revisions of formulary documents and systems are complete.
• Ensures HNPS’ compliance with CMS formulary requirements per the Medicare Prescription Drug Benefit Manual, Chapter 6 – Part D Drugs and Formulary Requirements
• Provides guidance and clarification for Part B v. Part D coverage determinations.

Education/Experience: Bachelor’s or Doctorate of Pharmacy degree. Two to four years experience working within a pharmacy or related health care environment. Minimum one year pharmacy residency training completed (or equivalent training/experience) preferred

License/Certification: Must have and maintain current, valid and unrestricted Pharmacist license in the state of employment.

Pay Range: $103,500.00 - $191,600.00 per year

Centene 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.  Total compensation may also include additional forms of incentives.

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.