• Job Description

  Req#: 1501725

  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.
  

  Clinical Pharmacist (Clinical Programs) - Remote EST

  Support Pharmacy Quality & Population Health Clinical programs with a focus on improving Medicaid QARR scores and collaborative Case Management programs to improve member outcomes

  Position Purpose: As a Clinical Pharmacist within the Fidelis Care Pharmacy Department, you’ll be part of a progressive specialty team focused on connecting vulnerable members with the services and treatment they need. Our purpose is to transform the health of the community one person at a time, and the individual values required for this team to achieve that include compassion, clinical quality, expediency, and forward-thinking initiative. On this team, utilizing our unique perspective as a health insurer, you will act as the pharmacy expert within a cross-collaborative, multi-faceted, care management team including medical utilization managers, social workers, registered nurses, medical directors, and more.

  Our access to claims information allows us to better deliver accurate, concise, and thoughtful pharmacy reviews in a member-specific, member-centric, and holistic manner. As a Clinical Pharmacist, you must be able to find a balance between managing large quantities of claims data while always maintaining respect for the distinct individual behind each data set.

  • Deliver high quality Complex Case Management reviews; including but not limited to, the specialty areas of HIV, Pre-Exposure Prophylaxis (PrEP), Sickle Cell Disease, Hemophilia, Substance Use Disorder, and High-Risk Diabetes (HRD). Maintain monthly/quarterly/biannual review requirements while meeting the quality goal on monthly internal audits. Recommend clinically sound, quality interventions in accordance with current clinical practice guidelines and internal policies and procedures. Provide professional and quality customer service during all communications with providers, members, and internal members of the organization.

  • Execute impactful and operationally sound Clinical Programs, centered around improvement of organizational NCQA and QARR measures. This includes conducting member and/or provider outreaches to encourage medication adherence, obtain/recommend updated laboratory information, recommend medication regimen changes as clinically appropriate, address relevant Drug-Drug Interactions, and collaboration with Care Managers to assist with linking members to the appropriate care. Programs include, but are not limited to:

  • HIV Viral Load Suppression measure (VLS)
  • Antidepressant Medication Management (AMM)
  • Follow-Up Care for Children Prescribed Attention-Deficit/Hyperactivity Disorder Medication (ADD)
  • Asthma Medication Ration (AMR)
  • Metabolic Monitoring for Children and Adolescents on Antipsychotics (APM)
  • Pharmacotherapy for Opioid Use Disorder (POD)
  • Adherence to Antipsychotic Medications for Individuals with Schizophrenia (SAA).

  • Facilitate interdepartmental Care Coordination by developing and maintaining relationships with key stakeholders within the organization; including but not limited to, HARP Case Management, PHCO Case Management, and the Restricted Recipient Program (RRP) to promote continued collaborative efforts on shared Case Management and Clinical Program initiatives.

  • Proactively identifying, and subsequently resolving, possible issues with access to prescribed medication by;

  • Generating on-demand reports and analyzing large quantities of data concerning various medication utilization patterns

  • Responding to member specific inquiries or concerns from other non-pharmacy teams within the multi-faceted care management team

  • Assisting with transitions of care between the outpatient and inpatient settings

  • Participating in collaborative integrated rounds sessions identifying and discussing the challenges for particularly high risk or unengaged members

  • Utilizing medical and pharmacy claims information provided by the PBM to increase access of care aligned with standard clinical practice guidelines, professional drug references, internal Fidelis Care formularies, and regulatory guidelines.

  • In addition to the routine team responsibilities, our pharmacists are encouraged to embrace a spirit of independent thinking and innovation. We believe that a team needs to be able to grow and develop together in order to obtain the best outcomes. Goal setting, professional development, problem resolution, taking initiative in process development/improvement, and providing thoughtful feedback is not only encouraged, but required.

  Education/Experience: Bachelor’s degree or advanced degree (Pharm.D., M.S.) in pharmacy. 2+ years of mail order, retail, hospital or managed care pharmacy experience or 1+ years of pharmacy residency program experience.
  
  Licenses/Certifications: Current state’s Pharmacist license with no restrictions.

  Desired Skills (Combination of and/or):

  • Managed Care - Medicaid

  • Case Management

  • Quality medicine reconciliation

  • Specialty Pharmacy

  • Excel – Data Analysis

  Working shift: Starting would be Monday-Friday 9am -5:30pm (EST) with possibility to shift into a 4- day work week.

  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.

• About the company

  Centene Corporation is a publicly traded managed care company based in St.

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