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About the Role

This fully remote leadership role will build and lead a new Medication Management team supporting the Mission Simplify Project, driving operational excellence in formulary setup, MedPharm codes, medical claims, and daily operations.

Responsibilities

• Manage the triage process of prior authorizations, including supervising pharmacy technicians.
• Manage departmental work flow.
• Identify and develop prior authorization procedures and policies.
• Coordinate with various departments to research and resolve escalated complaints and inquiries.
• Monitor prior authorization processes and recommend and modify current policies and procedures.
• Ensure operational integrity, including compliance with all associated policies and procedures.
• Monitor prior authorization activities and determine appropriate staffing levels.
• Oversee department performance and review reports and audit findings to ensure optimal performance is achieved.
• Ensure provider notification letters are communicated accurately and in a timely manner.
• Oversee quality control checks and provide recommendations for improvement.
• Communicate with providers and pharmacies to advise clinical outcome of prior authorization request.
• Oversee multiple pharmacy systems to track and triage prior authorization requests for Medicaid and coverage determination requests for Medicare D recipients and determine if a pharmacist review is required.

Requirements

• Prior medical claims experience required.
• Strong Microsoft Excel skills required.
• Must be comfortable presenting to leadership.

Skills

• Microsoft Excel

Location

• Remote (United States)

Work Type

• Fully remote
• Occasional travel

Experience Level

• 4+ years of pharmacy technician experience in a mail order prescription facility, hospital pharmacy or retail pharmacy setting.
• 1+ years of combined lead or supervisory and customer service experience.

Education Level

• Associates degree in related field or equivalent experience.

Salary/Compensations

• $70,100.00 - $126,200.00 per year

Benefits

• Competitive pay
• Health insurance
• 401K and stock purchase plans
• Tuition reimbursement
• Paid time off plus holidays
• Flexible approach to work with remote, hybrid, field or office work schedules

About the Company

• At Centene, we connect people to the care they need to live healthier lives — and the work you do here makes that impact real every day.
• You’ll take on meaningful challenges that directly support individuals, families, and communities, building your skills while making healthcare more accessible and effective.
• It’s work with a purpose you can see, backed by a team committed to improving lives well beyond the workday.

Equal Opportunity

• 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.