Clinical Pharmacist – Quality

Centene Corporation

. Define and develop standard and custom formularies for assigned plan .

Posted 9/29/2026full-timeRemote • United StatesJunior💰 $107,700 - $199,300 per yearWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates expertise in developing and implementing clinical criteria and formularies while ensuring compliance with state guidelines. Proficient in data analysis and providing clinical support within managed care and pharmacy settings.

Highest-signal resume keywords

Pharmacy DegreePharmacist LicenseClinical Pharmacy ExperienceData Analysis SkillsMicrosoft Excel Skills

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Formulary DevelopmentClinical Criteria DevelopmentPrior Authorization MonitoringQuality Control ImplementationDUR Program DevelopmentPharmacy Policy DevelopmentClinical EvaluationEvidence-Based Findings Application

Soft Skills

Interdepartmental CommunicationClinical Support

Certifications & Qualifications

Pharmacist License

Industry Keywords

Managed CareMedicaidMedicareClinical PharmacyHospital Pharmacy

About the role

Key responsibilities & impact

Define and develop standard and custom formularies for assigned plan
Develop clinical criteria for medications
Recommend plan design changes and clinical programs
Monitor prior authorization requests
Provide clinical support to internal departments and address clinical-related questions
Ensure appropriate quality controls and initiate opportunities for performance improvement in pharmacy/practice
Develop and implement programs designed to impact DUR for Medicaid and Medicare
Develop, implement, and maintain pharmacy department policies and procedures
Participate in coordination of the Medicare MTM program
Assist the case management team with members, including clinical rounds presentations
Contact providers regarding quality measures
Ensure clinical criteria align with state guidelines
Apply evidence-based findings to coverage policies and formulary decisions

Requirements

What you’ll need

Bachelor’s degree or advanced degree (Pharm.D., M.S.) in pharmacy
2+ years of experience in managed care, clinical, hospital or retail pharmacy experience OR 1+ years of pharmacy residency program experience
Current state’s Pharmacist license with no restrictions
Strong data analysis skills
Microsoft Excel skills
Ability to critically evaluate clinical trials, treatment guidelines, and drug literature
Background in clinical pharmacy, managed care, and/or hospital preferred
Illinois Pharmacist license preferred but not required

Benefits

Comp & perks

Competitive pay
Health insurance
401K plan
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 employer committed to diversity