Centene Corporation Senior Manager, Clinical Pharmacy Services - Prior Authorizations in Houston, Texas

ProfessionalPosition Purpose: Provides leadership for PBM Prior Authorization operations for clinical pharmacist and pharmacy technicians. Develops and implements quality improvement, clinical, and prior authorization initiatives. Ensures productivity and service levels are met or exceeds within assigned responsibilities.

Oversees the review of PBM Prior Authorization requests for coverage and make determinations for appropriate drug products.

Develops, implements, and maintains policies and procedures to ensure optimal performance over Pharmacy Technicians.

Researches and develops new cost reduction, pricing, quality improvement and revenue enhancement activities.

Ensures that the Clinical Pharmacy Services are in compliance with existing laws and regulations. Document and log any provider/physician complaints and ensure executive leadership is notified of complaints in a timely manner.

Ensures that the Clinical Pharmacy Services are in compliance with existing laws and regulations. Document and log any provider/physician complaints and ensure executive leadership is notified of complaints in a timely manner.

Develops, implements, and maintains appropriate policies and procedures. Participates in the development, coordination, and management of the operating and capital equipment budgets.

Builds strategic relationships with client’s key decisions makers. Serves as an expert resource to providers, health plans, and various departments.

Serves as an expert in benefit configurations for each health plan to facilitate appropriate adjudication of approved specialty medications or redirect as appropriate to an alternate channel for review per contractual requirements.

TITLE: Senior Manager, Clinical Pharmacy Services - Prior Authorizations

LOCATION: Houston, Texas

REQNUMBER: 1092445

COMPANY: Pharmacists

POSITION TYPE: Professional

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.