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Analyze pharmacy authorization criteria, and help to reword them in patient-friendly language suitable for member communication, while maintaining specificity and meaning of the original requirement. Assist in maintenance of member letter templates in line with state and plan guidelines, as well as NCQA standards.
Perform duties to support the efforts pharmacy department in the development, coordination and maintenance of the health plan’s pharmacy program.
Provides support for escalated issues and special projects as assigned.
Perform review of pharmacy and override process in compliance with pharmaceutical related company and State guidelines
Track and trend overrides to ensure criteria have been met, audit for prior authorizations, and determine utilization patterns
Resolve complaints and grievances related to the pharmacy network in conjunction with the Pharmacy team
Assist with the pharmacy utilization review and reporting process
Assist with the training and retention of employees
Assist with process improvements as needed
Education/Experience : High school diploma or equivalent. 5+ years of pharmacy experience, including 1+ years of managed care experience. Medicare and/or Medicaid experience.
License/Certification:Current Arizona Pharmacy Technician license.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.TITLE: Pharmacy Coordinator IILOCATION: Tempe, ArizonaREQNUMBER: 1198604COMPANY: Clinical & Care ManagementPOSITION TYPE: Both
