Clinical - Pharmacy Coordinator 1 - 210120

Below mentioned is the job description for your reference:

Job Title: Pharmacy Coordinator

Location: Remote
Duration: 6 months (Possible Extensions)
Work Hours: Monday Friday | 8:00 AM 4:30 PM (Flexible start/end times; no overtime required)

Position Summary:

• Centene Pharmacy Services is seeking a Pharmacy Coordinator to support the development, configuration, and maintenance of pharmacy decision tools (DTs) used in prior authorization processes.
• This role is key to ensuring accurate and timely configurations within the MHK/Compass platform to align with formulary requirements, drug policies, and pharmacy operational goals.
• The ideal candidate will bring strong pharmacy knowledge, high attention to detail, and the ability to manage multiple tasks independently in a fast-paced, collaborative environment.

Key Responsibilities:

• Configure pharmacy decision tools (questionnaires) using Excel-based loaders for uploading to the MHK/Compass platform.
• Conduct QA and testing of configured tools to ensure alignment with plan requirements and functional accuracy.
• Maintain and update existing decision tools as part of monthly configuration cycles and integration efforts (e.g., Express Scripts).
• Collaborate with pharmacy operations teams to gather configuration requirements and ensure decision tools reflect correct clinical policy.
• Address provider/pharmacy inquiries related to prior authorization and formulary processes.
• Support tracking and trending of overrides, cost analysis, and utilization patterns.
• Assist in resolving complaints and grievances related to pharmacy services and benefit structures.
• Partner with internal departments, such as Provider Relations and Quality Improvement, to ensure smooth workflow integration and support for providers and members.
• Adhere to quality, compliance, and documentation standards as set by Centene and applicable state/federal guidelines.

Required Qualifications:

• High school diploma or equivalent.
• 3+ years of pharmacy experience (PBM, retail, managed care, or clinical settings).
• Proficiency in Microsoft Office Suite, particularly Excel, Word, Outlook, and Visio.
• Strong organizational and multitasking abilities with high attention to detail.
• Demonstrated ability to work independently while maintaining clear and timely communication with project stakeholders.

Preferred Qualifications:

• Pharmacy Technician License (current or eligible to obtain within 30 days of start date).
• Experience in a managed care environment and/or familiarity with Medicare/Medicaid regulations.
• Previous experience in configuring or working with pharmacy systems (MHK, Compass, or similar tools).
• Background in projects or quality improvement efforts within pharmacy operations.

Performance Expectations:

• Timely and accurate completion of configuration tasks.
• High attention to detail in all QA and documentation.
• Ability to follow detailed training instructions and standard procedures.
• Maintain productivity and accuracy across monthly configuration cycles.
• Effective collaboration and communication within cross-functional pharmacy teams.