Position Purpose: Define and develop standard and custom formularies for assigned plan.
Key Details: Clinical Pharmacist (Quality). This remote position works a Monday through Friday schedule from 8:00 AM to 5:00 PM Central Time and focuses on project-based quality initiatives that support clinical and formulary decision-making. Key responsibilities include creating and updating clinical policies, contacting providers regarding quality measures, ensuring clinical criteria align with state guidelines, and applying evidence-based findings to coverage policies and formulary decisions. The ideal candidate will possess strong data analysis and Microsoft Excel skills, along with the ability to critically evaluate clinical trials, treatment guidelines, and drug literature. A background in clinical pharmacy, managed care, and/or hospital is preferred. Illinois Pharmacist license is preferred but not required.
- Develop clinical criteria for medications, recommend plan design changes, and clinical programs to be initiated
- Monitor prior authorization requests
- Provide clinical support to internal departments and address clinical related questions
- Ensure appropriate quality controls and initiates opportunities for performance improvement in pharmacy/practice
- Develop and implement programs designed to impact DUR for both Medicaid and Medicare
- Develop, implement, and maintain policies and procedures for the pharmacy department
- Participate in the coordination of the Medicare MTM program
- Assist case management team with members including clinical rounds presentations
Education/Experience: 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.
Licenses/Certifications: Current state’s Pharmacist license with no restrictions.
At Centene, we connect people to the care they need to live healthier lives — and the work you do here makes that impact real every day. You’ll take on meaningful challenges that directly support individuals, families, and communities, building your skills while making healthcare more accessible and effective. It’s work with a purpose you can see, backed by a team committed to improving lives well beyond the workday.
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, 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
