Clinical Audit Coordinator (Pharmacy)

About the role

We are seeking a Pharmacy Clinical Audit Coordinator to play a key role in pharmacy quality and compliance operations. In this position, you will leverage your pharmacy expertise to audit prior authorization activities, identify opportunities for process improvement, support clinical training initiatives, and help maintain the integrity of critical pharmacy systems and data.

Responsibilities

• Assist with pharmacy clinical training programs and audits of clinical systems entry and/or processes.
• Assists with auditing staff and vendor partners in accordance with established CMS guidelines
• Partner with business groups to identify and resolve errors in data and reporting, and present findings and recommendations for improvement to management
• Assist with the administration of audit processes and tools related to prior authorizations, appeals, quality improvement, star measurement reviews, inter-rater reliability and data entry
• Assess training needs and identify, select or develop appropriate training programs including training aids and materials
• Assist with training staff in the use of audit tools and identification of patterns or trends that require additional training or corrective action
• Maintain records of training activities and employee progress
• Participate in Quality and Advisory committees or provider education meetings

Requirements

• Pharmacy technician (CPhT) with experience working with Compass, TruCare, or CareCentral.
• Quality assurance on MedPharm (TruCare, ComPass and CareCentral) prior authorization requests.
• Clinical understanding of Medicare, Medicaid, Exchange and Commercial plans is a plus.
• Microsoft Excel & Access proficiency
• Working shift: 9:30am - 6pm (Eastern / EST)

Qualifications

High school diploma or equivalent. 2+ years of pharmacy technician experience in a managed care or healthcare setting. Audit experience preferred. Current State’s licensure or Certified Pharmacy Technician (CPhT), preferred

Pay

Pay Range: $23.23 - $39.61 per hour. Actual pay will be adjusted based on an individual's skills, experience, education, and other job-related factors permitted by law, including full-time or part-time status. Total compensation may also include additional forms of incentives.

Benefits

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.