Manager, Clinical Pharmacy Operations (Medicare Part D)

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: The Manager of Clinical Pharmacy Operations-Medicare Part D is responsible for developing, implementing and administering clinical pharmacy tools and programs to support corporate and regional drug utilization and financial goals.

• Oversees the daily Medicare Part D clinical pharmacy operations including, but not limited to, monitoring of the formulary change process, overseeing the transition fill program, analyzing rejected and paid pharmacy claims, scrutinizing pharmacy claims messaging.

• Manages, coordinates, monitors and evaluates the activities of the department staff. Oversees the employment, performance evaluation, training, motivation and counseling of assigned associates.

• Ensures HNPS’ compliance with Formulary Administration and Transition Fill Program requirements in addition to all CMS requirements relative to Medicare Part D.

• Provides clinical and operations support for planning, creating, maintaining and reviewing HN Medicare Part D Formularies, Prior Authorization criteria, Step Therapy criteria and other utilization management restrictions.

• Ensure timely and accurate submission of all HPMS formulary files, PA files, ST criteria and negative formulary changes.

• Oversees the QA process for maintaining accurate HN Medicare Part D formularies in the Formulary and Benefit system.

• Acts as a clinical liaison between HNPS and CMS and the pharmacy claims processor.

• Leads efforts and participates in the development and maintenance of new programs required by CMS.

• Creates/revises policies and procedures pertaining to Health Net, Inc. Medicare Part D program

Education/Experience: Pharm D or equivalent experience in Pharmacy. 4 years' experience working within a pharmacy or related health care environment required. 3 years management experience required. Medicare Part D operations with emphasis on formulary management, preferred.

License/Certification: Maintain current, valid and unrestricted Pharmacist License.

Job Specific Details:

• Participating in Zoom/Webex/MS Teams meetings to support routine operational responsibilities in addition to key projects involving Medicare formularies.

• Providing support to direct reports to execute on key tasks related to maintenance of business or special projects.

• Analyzing new Medicare guidance or PBM alerts to determine if any formulary support is needed.

• Collaborate with other team members to address any formulary issues or inquiries submitted to the team from other areas of the business.

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.

Qualified applicants with arrest or conviction records will be considered in accordance with the LA County Ordinance and the California Fair Chance Act