Director, Medicare Part-D Coverage Determinations Clinical Pharmacy Operations

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Director, Medicare Part-D Coverage Determinations Clinical Pharmacy Operations

USA-California-Rancho Cordova, USA-Arizona-Tempe, USA-Texas-Houston

This Position is Responsible for the Medicare Part-D Determinations


Position Purpose: Develop, implement and oversee the clinical pharmacy

operations department that serves multiple product lines in both

centralized and regional environments with multiple locations.

Oversee the clinical pharmacy operations business unit, including the

support of client implementation of prior authorization, drug

utilization review programs, and plan specific management initiatives

Ensure regulatory compliance and turnaround times by overseeing the

staffing and scheduling of clinical pharmacists and technicians

Direct the development of new cost reduction, pricing, quality

improvement and revenue enhancement activities

Develop and manage the operating and capital equipment budgets

Monitor performance and provide recommendations to improve department

efficiency and quality

Support the development of organizational policies and procedures,

including pharmacy service quality, pharmacy utilization management

and achievement of company goals

Oversee the clinical operations unit to ensure that relevant

performance standards are met for all clients

Oversee the resolution of disputes, grievances and complaints

involving pharmacy program issues

Participate in internal and external accreditation initiatives, task

forces, committees, meetings and other activities

Support clinical programs that support accreditation for HEDIS, URAC,


Consultation with staff in the field

Senior Clinical staff will have direct oversight of qualified

clinicians accountable for decisions affecting consumers

Education/Experience: PharmD degree or advanced pharmacy degree. MBA

or advanced degree in Business preferred. 7+ years of clinical or

operational pharmacy services experience, including 5+ years of

pharmacy benefit management experience. Strong understanding of

clinical, operational, and regulatory compliance programs and

services. PBM, managed care, or quality improvement experience


License/Certification: Current state s Pharmacist license without


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.

USA-Texas-Houston, USA-Arizona-Tempe, USA-Texas-Austin

  • 1
  • Negotiable
  • None
  • None
  • Re-204997
  • Permanent
  • 0

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