Title: Clinical Pharmacist 1
Duration: 6 months possible extension
Location: Remote (Preferred NC, AZ, KS, TX, IN, GA, NJ, CA, FL)
Schedule:
8 hour shift (typically 9am-5:30pm in worker's timezone)
Job Decsription:
* 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
- Purpose: Primary duty for this position is to review prior authorization requests for medical benefit (buy and bill) drugs requests across the Medicare, Medicaid, Exchange, and Commercial lines of business
- This position is fully remote. We prefer a candidate with strong clinical skills, drug knowledge, and managed care experience in prior authorization review. We expect a candidate that embodies Centene culture.
- Accountability: Setting clear goals, being transparent about outcomes, and inviting feedback to foster growth.
- Courage: Pushing past fear and uncertainty to make the best possible decisions.
- Curiosity: Approaching every interaction as an opportunity to learn.
- Trust: Demonstrating integrity, honesty, and vulnerability to build strong relationships.
- Service: Focusing our work through the lens of our mission.
- This request is a temp backfill position for a permanent rec (recent pharmacist promotion). This position is eligible for temp to perm
- *Our department receives and reviews prior authorization requests for medical benefit (buy and bill) drugs requests across the Medicare, Medicaid, Exchange, and Commercial lines of business
*They will be required to review the doctor's request based on defined criteria to determine if the medication can be approved or denied.
*The RFS production goal is 90%. This goal should be met daily and monthly. This goal roughly averages to 47 cases completed per day.
The quality goal is 99.9%.
| Education/Certification |
Required: Bachelor's or Doctorate of Pharmacy degree. |
Preferred: |
| Licensure |
Required: Current state's Pharmacist license with no restrictions. |
Preferred: Pharmacist Licenses we required based on business needs:
- NC
- AZ
- KS
- TX
- IN
- GA
- NJ
- CA
- FL
|
Years of experience required: 1+ years of retail, hospital, managed care, or PBM experience. Previous experience with reviewing prior authorizations for a managed care organization/PBM.
Disqualifiers:
Additional qualities to look for: Preferred experience with outlook, teams, SharePoint, excel
|
- Top 3 must-have hard skills stack-ranked by importance
|
1 |
Decisive clinical decision making |
| 2 |
Flexibility/adaptability |
| 3 |
Quick learner |
|
Spectraforce Technologies
Oct 22, 2026