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Clinical Formulary Pharmacist
Centene Corporation. Define and develop standard and custom formularies for Commercial, Medicaid, Medicare Part D and Health Information Marketplace lines of business .
Core Competencies
Role fitCore Competencies
Use this summary to align your resume positioning with the role.
Demonstrates expertise in formulary development and clinical criteria design for managed care pharmacy, with a strong focus on regulatory compliance and drug utilization analysis. Provides clinical guidance and support while ensuring adherence to pharmacy benefit design and medication protocols.
Highest-signal resume keywords
Formulary DevelopmentClinical Criteria DesignRegulatory ComplianceDrug Utilization AnalysisPharmacy Benefit Design
ATS Keywords
Tailor your resumeApplicant Tracking System Keywords
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Hard Skills
Drug Product ReviewMedication AnalysisPrior Authorization GuidelinesClinical Edits DevelopmentCost AnalysisDrug Utilization ReviewPharmacy Technician SupportClient ReportingTrend AnalysisClinical Guidance
Soft Skills
CommunicationCollaborationProblem-SolvingLeadership
Certifications & Qualifications
Pharmacist License
Industry Keywords
Managed Care PharmacyMedicaidMedicare Part DHealth Information MarketplacePharmacy and Therapeutics CommitteeDrug Utilization ReviewFraud and Abuse Reporting
About the role
Key responsibilities & impact- Define and develop standard and custom formularies for Commercial, Medicaid, Medicare Part D and Health Information Marketplace lines of business
- Develop drug product reviews and formulary recommendations by assessing drug use trends, new drug releases and primary literature
- Analyze pharmacy cost of care and trends, and coordinate appropriate use protocols and guidelines
- Set medication analysis criteria and coordinate client reports
- Meet regulatory reporting requirements for drug utilization review and fraud and abuse reporting
- Develop clinical criteria for non-formulary or non-preferred drug list medications and communicate recommendations to clients
- Develop and design clinical edits to adjudicate claims and enhance drug utilization
- Develop and review prior authorization and non-formulary drug guideline criteria in support of Pharmacy and Therapeutics Committee functions and pharmacy benefit design
- Research drug information for prior authorization reviews and disease state understanding
- Provide clinical guidance and support to assigned pharmacy technicians
- Provide support documentation and communications for Pharmacy & Therapeutics Committee reviews and decisions
- Perform other duties as assigned
- Comply with all policies and standards
Requirements
What you’ll need- Bachelor’s degree or advanced degree (PharmD., M.S) in pharmacy
- 3+ years of combined managed care pharmacy or pharmacy residency program experience
- Current state’s Pharmacist license with no restrictions
- Candidates located in the CST or EST time zones are preferred
- During the first 6 months, availability for training and work hours providing at least 75% overlap with the team’s 8:00 AM–4:30 PM PST schedule
Benefits
Comp & perks- Competitive pay
- Health insurance
- 401K plan
- Stock purchase plan
- Tuition reimbursement
- Paid time off plus holidays
- Flexible approach to work with remote, hybrid, field or office work schedules
- Additional forms of incentives may be included in total compensation