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- Resolve complaints and grievances related to the pharmacy network in conjunction with the Pharmacy team
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- Collaborate with Quality Improvement department with various meeting preparation and transcription of minutes
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- Set up the appeals to have them reviewed by a RPh or Medical Director.
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- Correctly verify drug, dosage, quantity, provider, diagnosis information.
- Review prior authorization criteria to that is used in denial.
- Enter overrides for approvals as Vendor and Biopharmacy.
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Pharmacy Coordinator - Maitland, United States - Centene Corporation
Description
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.
Pharmacy Coordinator - (Grievances, Appeals, and Prior Authorizations) Remote -- 10am - 6pm, 11am - 7pm or 12pm - 9pm Eastern / EST. Tuesday-Saturday or Sunday-Thursday
Position Purpose: Perform duties to support the efforts pharmacy department in the development, coordination and maintenance of the health plan's pharmacy program.
For Centene Pharmacy Services
Education/Experience: High school diploma or equivalent.
3+ years of pharmacy experience, preferably in a managed care environment. Medicare and/or Medicaid experience preferred. Advanced Microsoft office experience preferred (Excel, Word, PowerPoint, Visio). Prior experience using analysis tools or systems (ex: web based, custom, proprietary, etc.). Experience in the implementation of quality process improvement efforts. Experience documenting requirements, creating training materials and working directly with end users. Excellent verbal and written communication skills. Strong analytical skills with attention to detail. Ability to exercise independent judgment. Ability to manage deliverables in a high pace environment.
License/Certificate: Current state's Pharmacy Technician license preferred.
Nationally Certified Pharmacy Technician (PTCB / NHA CPhT), highly preferred
Prior Authorization with Appeals experience, highly preferred.
Job specific responsibilities:
Working shift: Flexible to work 10am-6pm, 11am-7pm or 12pm-9pm (Eastern / EST). Tuesday-Saturday (with Sunday/Monday off) Or Sunday-Thursday (with Friday/Saturday off).
The Saturday or Sunday shifts are 8am – 4:30pm or 9:30pm – 6pm (EST)
No earlier shift or Monday – Friday available. The actual shift will be assigned by team at time of offer.
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.
