Senior Pharmacy Resolution Specialist at Centene

You are an experienced healthcare professional with at least two years of background in pharmacy operations, managed care, or retail settings. A high school dip

Work type: remote

Location: Remote-CA

Salary: $19 – $33/hr

Type: Full-time

Summary

You are an experienced healthcare professional with at least two years of background in pharmacy operations, managed care, or retail settings. A high school diploma or GED is required, while a pharmacy technician certification is preferred for this position. **What makes it worth a look...** Centene offers a fully remote schedule for this role, provided you are available to work the 2:00PM to 10:30PM EST shift. The position pays between $19.43 and $32.98 per hour and includes a full benefits package with a 401K plan and tuition reimbursement. **You might be a good fit if you...** * Have at least two years of experience in a healthcare or pharmacy environment. * Possess a proven background in high-volume call center or customer service settings. * Can navigate complex prior authorization requests and pharmacy benefit inquiries. * Are comfortable acting as a technical resource to guide team members through difficult case resolutions.

Job Description

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.
 

Qualified candidates must be able to work 2:00PM-10:30PM EST.Must be authorized to work in the U.S. without the need for employment-based visa sponsorship now or in the future. Sponsorship and future sponsorship are not available for this opportunity, including employment-based visa types H-1B, L-1, O-1, H-1B1, F-1, J-1, OPT, or CPT.Position Purpose: The Senior Pharmacy Resolution Specialist will act as a subject matter expert and handles more complex pharmacy issues and respond to escalated calls from members, provider/physician's offices and pharmacies. This role will make outbound calls and enters pharmacy overrides into systems based on approved guidelines and approvals provided from clinical pharmacists.

• Takes member/prescriber/pharmacist inquiry calls for benefit questions including prior authorization requests

• Offers options including submission of a prior authorization request

• Thoroughly researches issues and takes appropriate action to resolve them using the appropriate reference material within turnaround time requirements and quality standards

• Answers and conducts inbound and outbound calls with members and provider offices to provide resolution to claims (i.e.: additional information requests and medication determination updates)

• Thoroughly researches issues and takes appropriate action to resolve them within turnaround time requirements and quality standards

• Assists team members often guiding them to the appropriate resolution of more complex and difficult inquiries

• Participates in the training of less experienced staff, including opportunity for job shadowing

• Acts as a liaison between internal departments on data gathering and problem solving while investigating problems of an unusual nature in the area of responsibility

• Presents proposed solutions in a clear and concise manner

• Assists with audit preparation as needed

• Assists with miscellaneous special project work as assigned

• Performs other duties as assigned

• Complies with all policies and standards

License/Certification: Pharmacy technician certification preferred.

Pay Range: $19.43 - $32.98 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, including full-time or part-time status.  Total compensation may also include additional forms of incentives. Benefits may be subject to program eligibility.

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