Pharmacy Coordinator II
Posted on: 16 Feb 2021
Tempe, AZ
Job Description
Position Purpose:
Perform duties to support the efforts pharmacy department in the development, coordination and maintenance of the health plan's pharmacy program. Provides support for escalated issues and special projects as assigned.
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* Receive and respond to provider, member, and pharmacy calls regarding the prior authorization and formulary process
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* Perform review of pharmacy and override process in compliance with pharmaceutical related company and State guidelines
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* Track and trend overrides to ensure criteria have been met, audit for prior authorizations, analyze cost and determine utilization patterns
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* Resolve complaints and grievances related to the pharmacy network in conjunction with the Pharmacy team
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* Assist Provider Relations and various departments with educating providers on the health plan's pharmacy process
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* Assist with the pharmacy utilization review and reporting process
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* Assist with the training and retention of employees
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* Assist with process improvements as needed
Education/Experience:
High school diploma or equivalent. 5+ years of pharmacy experience, including 1+ years of managed care experience. Medicare and/or Medicaid experience.
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.
WellCare
Tampa, FL
WellCare Health Plans, Inc. provides government-sponsored managed care services. The company operates in three segments: Medicaid Health Plans, Medicare Health Plans, and Medicare Prescription Drug Plans (PDPs). The Medicaid Health Plans segment offers plans for beneficiaries of temporary assistance for needy families, supplemental security income, and aged blind and disabled residents; and other state-based programs, such as children's health insurance programs and long-term services and supports programs for qualifying families who are not eligible for Medicaid.
The Medicare Health Plans segment provides Medicare, a federal program that provides eligible persons aged 65 and over, as well as some disabled persons with a range of hospital, medical, and prescription drug benefits; Medicare Advantage, a Medicare’s managed care alternative to the original Medicare program, which offers individuals standard Medicare benefits directly through Centers for Medicare & Medicaid Services; and coordinated care plans that are administered through health maintenance organizations and require members to seek health care services and select a primary care physician from a network of health care providers.
The Medicare PDPs segment provides Medicare part D PDP plans to Medicare-eligible beneficiaries. Its PDP plans offer national in-network prescription drug coverage, including a preferred pharmacy network. As of December 31, 2018, the company served approximately 5.5 million members in the United States. WellCare Health Plans, Inc. was founded in 1985 and is headquartered in Tampa, Florida.
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IndustryHealthcare
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No. of Employees12, 000
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Website
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Jobs Posted917
