Centene Corporation

Manager, Pharmacy Operations (Data / Business Analyst) - Remote. Provide strategic direction and leadership for the health plan and specialty company business units in identifying, developing and implementing innovative initiatives to improve overall outcomes. 4+ years of healthcare operations management (pharmacy operations, medical management, quality improvement, compliance).. Collaborating with internal Enrollment, Benefits and IT teams as well as external vendors to ensure accurate adjudication of pharmacy claims. Centene offers a comprehensive benefits package including competitive pay, health insurance, 401K and stock purchase plans, tuition reimbursement, paid time off plus holidays, and a flexible approach to work with remote, hybrid, field or office work schedules.

pharmacy operations

You could be the one who changes everything for our 28 million members as a clinical professional on our Medical Management/Health Services team. Centene is a diversified, national organization offering competitive benefits including a fresh perspective on workplace flexibility. Manager, Pharmacy Operations (Data / Business Analyst) - Remote Position Purpose Provide strategic leadership on pharmacy initiatives to ensure best in class outcomes for all Centene health plans. Collaborate with internal and external stakeholders to ensure pharmacy initiatives are fully integrated throughout the organization, maximizing opportunity to improve outcomes for members. <ul><li>Provide strategic direction and leadership for the health plan and specialty company business units in identifying, developing and implementing innovative initiatives to improve overall outcomes</li><li>Research, identify, and implement best practices into operations in collaboration with all health plan and specialty company business units to standardize operations</li><li>Organize and oversee activities, resources, methods, and procedures to achieve Centene’s enterprise-wide strategic vision</li><li>Formulate and ensure adherence with policies, operating procedures, and goals in compliance with internal and external governing bodies</li><li>Manage relationships with key vendors such as pharmacy benefit management companies and pharmaceutical companies</li><li>Review and analyze reports, records and directives, and confer with staff to obtain data required for planning work function activities</li><li>Conduct statistical analysis of data related to utilization and prepare and present results to management </li></ul>Education/Experience Bachelor’s degree in Business Administration, Health Care Administration or equivalent experience. Master’s degree preferred. 4+ years of healthcare operations management (pharmacy operations, medical management, quality improvement, compliance). Previous experience as a lead in a functional area, managing cross functional teams on large scale projects or supervisory experience including hiring, training, assigning work and managing the performance of staff. Job Specific Duties <ul><li>Manage and lead a team of 4-5 Analyst</li><li>Design and implement data integrity processes to identify any defects and inaccuracies - Implement corresponding processes to preclude future defects</li><li>Evaluating systems and processes for opportunities to optimize performance, accuracy and efficiency.</li><li>Manage and lead the support process to resolve critical defects reported by the members, compliance or program management</li><li>Authoring requirements and test documents for various applications </li><li>Collaborating with cross-functional teams to deliver application architectures and improved business processes</li><li>Collaborating with internal Enrollment, Benefits and IT teams as well as external vendors to ensure accurate adjudication of pharmacy claims </li></ul>Highly Desired Skills/experience <ul><li>Leadership</li><li>Data analysis</li><li>Technical analysis reviewing compliance and business requirements</li><li>Strong SQL and database experience</li><li>High level of analytical skills and ability to understand complex systems</li><li>Pharmacy adjudication processes</li><li>Designing /building queries </li></ul>Pay Range $84,300.00 - $151,700.00 per year Centene offers a comprehensive benefits package including competitive pay, health insurance, 401K and stock purchase plans, tuition reimbursement, paid time off plus holidays, and a flexible approach to work with remote, hybrid, field or office work schedules. Actual pay will be adjusted based on an individual's skills, experience, education, and other job-related factors permitted by law. Total compensation may also include additional forms of incentives. 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.

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