Pharmacy Operations Specialist II

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: This role will focus on ensuring that the administration of the pharmacy program is accurate and compliant by supporting various operational tasks. This role will serve as the subject matter expert supporting various pharmacy operations tasks including but not limited to claims, formulary, benefit, and networks.

• Ability to conduct data analysis to support operations and exercise independent judgement
• Provides support for escalated issues and special projects as assigned
• Conduct UAT to ensure that systems reflect accurate information
• Serve as the subject matter expert supporting various pharmacy operations tasks including but not limited to claims, formulary, benefit, and networks
• Serve as the subject matter expert related to specific pharmacy documents to ensure they are accurate and compliant
• Performs other duties as assigned
• Complies with all policies and standards

Education/Experience: High school Diploma or GED, Bachelor’s degree preferred, 4+ years of pharmacy experience, including 1+ year of managed care experience. Government sponsored program (Medicare and/or Medicaid) experience preferred.

License/Certification: Current state’s Pharmacy Technician license preferred

Day-to-Day

• Serve as a project manager/lead for Medicare Part D and Part B medication related benefit setup, testing, oversight, and audit activities

• Develop, lead, and oversee data driven reporting for the purpose of presenting activities and outcomes to Sr Mgmt

• Develop, lead, and oversee workflows, processes, and automation to help conduct our testing and tracking of benefit setup and functionality

• Serve as a SME for all Medicare Part D and Part B benefit requirements as dictated by CMS and State Regulatory agencies

• Work with Medicare formularies in conjunction with execution of benefit testing and oversight

• Work with Medicare communications that relate to transition, EOB, and ANOC

Desired skills & experience

• Pharmacy Medicare Part D & B benefits (understanding what they are and how they are setup)

• Pharmacy Medicare Part D & B formulary (understanding what they are and how they are setup)

• Experience with and knowledge of managed care

• Project management experience

• Advanced skills with Excel, Access, Power BI, Power Automate

• Experience in managing data and processes with focus on workflow and automation of processes.

• Assist in modernizing our processes to include the use of tools such as Power BI, Power Automate and other tools to help automate our processes and workflow

• Information analysis for problem solving or solution development

• Experience with pharmacy claims processing and benefit setup

• Experience with Root Cause analysis and identifying the root causes of faults or problems

Working shift: Remote - Must be available normal business hours in your location but available for specific meetings based on other time zones.

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