What are the responsibilities and job description for the Pharmacy Operations Coordinator I position at Centene Management Company LLC?
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.
- Perform duties to support the development, coordination and maintenance of the pharmacy program.
- Review benefit/formulary setup and testing (new and year over year).
- Conduct claims analysis
- Performs other duties as assigned
- Complies with all policies and standards
Education/Experience: High School Diploma or GED. 2 years of pharmacy experience in managed care environment preferred
License/Certification: Current state’s Pharmacy Technician license preferred
Working shift: 8:00 AM – 4:30 PM (PST /Pacific Standard Time) Monday - Friday. Department has PTO/Vacation block from mid-December thru mid or end of January of next year.
Job specific details:
Troubleshoot pharmacy requests/issues related to benefit setup.
Support upkeep with maintenance of pharmacy business request, including updating benefit master grid, submitting and resolving requests/issues through third party portal, validate test files to ensure implementation intent.
Researching of pharmacy issues reported, interpreting/deciphering requests, internal documents, and (or) comments/responses from internal/external partners, navigating systems (i.e., Reclaim, Client Care Access Portal, FABM SharePoint/Reference Tools).
Excel - Validating large volume data (I.e., VLOOKUP)
Support integration and migration including Medicaid, Ambetter, WellCare, and HealthNet
Often attend daily meetings
Support other team members where needed.
Highly desired skills:
Knowledgeable in pharmacy benefits set-up, validation & testing
Analytical - Experience researching issues and requests
Excel - Validating large volumes data
Excel - Data analysis
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
Salary : $19 - $32
