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.

Remote position. Hours are 9-6 EST

Position Purpose: Track and triage all coverage determination requests for prior authorizations and Medicare Part D recipients.

• Support Medicaid prior authorization requests by approving coverage determination requests based on defined criteria Document prior authorization determination requests into the PBM system and notify providers and/or members
• Track and triage all prior authorization requests for Medicaid and coverage determination requests for Medicare D Recipients and determine if a pharmacist review is required
• Obtain verbal authorizations and request detailed clinical information from prescribers
• Assist with complex coverage approvals and determination requests based on defined criteria
• Enter and document coverage determination request decision into pharmacy system and notify providers and/or members
• Respond to client inquiries regarding authorization approvals and PBM online applications
• Refer coverage determination requests for specialty drugs to delegated vendor or client for processing
• Contact providers for additional information to facilitate coverage determination reviews
• Assist management in delivering training material to pharmacy technicians
• Work weekend or alternative shifts as needed

Education/Experience: High school diploma or equivalent. 3+ years of retail, hospital or mail order pharmacy experience. Working knowledge of Microsoft Suite and pharmacy systems.

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

For Fidelis Care Only: National Pharmacy Technician Certification Required within 90 daysPay Range: $18.66 - $31.73 per hour

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.