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.

Position Purpose: Serve as the primary point of contact and liaison between account management and specialty pharmacy operations. Responsible for facilitating the resolution of specialty pharmacy escalated issues from the account management team's payer clients.

• Experience in Referral Processing and pharmacy is highly preferred
• Investigate and provide resolution to payer concerns regarding specialty dispenses to members
• Analyze and monitor payer complaints to identify trends; develop and implement action plans to maintain high levels of quality service
• Collaborate with account management and specialty pharmacy operations departments to investigate and resolve all issues
• Expedite urgent orders and follow through to dispense
• Document and provide status updates on outstanding issues
• Monitor high risk members and prescriptions to mitigate risk
• Work with internal teams to enhance processes based on expertise and client insight
• Mentor, develop and train newly hired team members as assigned.
• Performs other duties as assigned
• Complies with all policies and standards

Education/Experience: Associate’s degree in related field or equivalent experience. 5+ years’ experience in pharmacy operations (intake and insurance verification, call center). Knowledge of pharmacy operational processes (intake and insurance verification, call center, pharmacy dispensing). Experienced ScriptMed user.Pay Range: $23.23 - $39.61 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.

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