Clinical Pharmacist

Centene Corporation

. Process and review prior authorization requests for non-formulary medications for clinical appropriateness .

Posted 9/23/2026full-timeRemote • Florida • United StatesJunior💰 $107,700 - $199,300 per yearWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates expertise in clinical pharmacy knowledge and professional clinical judgment, with a strong focus on prior authorization processes and managed care operations. Proficient in evaluating medication requests and communicating effectively with healthcare professionals.

Highest-signal resume keywords

Pharmacist LicenseClinical Pharmacy KnowledgePrior Authorization ExperienceUtilization ManagementManaged Care Operations

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Prior Authorization ProcessingClinical JudgmentChart Note ReviewLab Value EvaluationPrescription Claim History AnalysisFormulary Criteria AssessmentData CompilationPharmacy Claims AuditingDrug Reference ResearchCriteria Development

Soft Skills

CommunicationCollaborationAttention to DetailProblem-Solving

Certifications & Qualifications

Pharmacist LicenseHealth Plan Credentialing

Industry Keywords

Managed CareUtilization ManagementPharmacy OperationsFormulary ManagementP&T Committee

About the role

Key responsibilities & impact

Process and review prior authorization requests for non-formulary medications for clinical appropriateness
Review completed prior authorization requests and pharmacy technician recommended denials, formulary alternatives, comments, and attachments
Verify member identification, date of birth, eligibility, carrier and group information
Check previous prior authorization decisions and verify prescription and health plan benefit coverage
Evaluate prescription claim history, chart notes, lab values, provider specialty, and medical policy criteria
Determine whether requests meet approval criteria using case-by-case professional clinical judgment
Review medication requests not addressed by P&T Committee criteria or guidelines and develop and draft criteria
Research and contribute drug references and clinical information for prior authorization review
Communicate with physicians and pharmacy technicians regarding non-formulary drugs, benefits, exclusions, quantity limits, age restrictions, and formulary alternatives
Retrieve, collect, and compile data for reporting purposes
Audit pharmacy claims greater than $200.00
Suggest additions or deletions to the formulary and update quantity/day or age-limit entries
Support the National P&T Committee
Perform other related duties as needed

Requirements

What you’ll need

Must be authorized to work in the U.S. without the need for employment-based visa sponsorship now or in the future
Bachelor’s or Doctorate of Pharmacy degree
One year prior experience
Must have and maintain current, valid and unrestricted Pharmacist license in the state of employment
Must be credentialed by the health plan of employment
May be required to obtain additional state licensure based on business needs
Experience in managed care, utilization management, prior authorization, or health plan pharmacy operations is preferred
Participation in periodic weekend and holiday coverage rotations
Clinical pharmacy knowledge and professional clinical judgment
Ability to review chart notes, lab values, prescription claim history, benefits, and formulary criteria

Benefits

Comp & perks

Competitive pay
Health insurance
401K
Stock purchase plans
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
Equal opportunity and diversity commitment