Senior Pharmacy Resolution Specialist at Centene

You are an experienced pharmacy professional or pharmacy technician with at least two years of experience in managed care, hospital, or retail settings. You mus

Work type: remote

Location: Remote-CA

Salary: $19 – $33/hr

Type: Full-time

Summary

You are an experienced pharmacy professional or pharmacy technician with at least two years of experience in managed care, hospital, or retail settings. You must possess a high school diploma or GED and meet all U.S. work authorization requirements without sponsorship. **What makes it worth a look...** Centene offers a fully remote role paying $19.43 to $32.98 per hour. The position includes a comprehensive benefits package featuring health insurance, a 401K plan, tuition reimbursement, and paid time off. **You might be a good fit if you...** * Hold an active pharmacy technician certification. * Have direct experience handling pharmacy prior authorizations and claims resolutions. * Are comfortable managing high-volume inbound and outbound calls in a clinical environment. * Can navigate complex pharmacy benefit inquiries and provide technical guidance to team members.

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.
 

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 CPTPosition 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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