Pharmacy Coordinator (FWA)

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.

About the Role

• Review and respond to fraud, waste, and abuse (FWA) referrals, inquiries, and requests from internal and external stakeholders.
• Support regulatory requests, reporting, and documentation related to FWA investigations and reviews.
• Research and help resolve concerns involving inappropriate billing, waste, and potential FWA activity.
• Communicate with members, providers, and pharmacies to gather information and support preliminary reviews.
• Generate and analyze reports to identify trends, support investigations, and assist with program oversight.
• Contribute to department process improvements and maintain accurate documentation.
• Perform duties to support the pharmacy department's efforts in the development, coordination, and maintenance of the health plan's pharmacy program.
• Receive and respond to provider and pharmacy calls regarding pharmacy benefits.
• Resolve complaints and grievances related to the pharmacy network in conjunction with the Pharmacy team.
• Assist various departments in educating providers on the health plan’s pharmacy processes.
• Assist with the pharmacy utilization review and reporting process.
• Assist with member inquiries.
• Perform other duties and activities as assigned.
• Comply with all policies and standards.

Requirements

• High school diploma or equivalent.
• 3+ years of pharmacy technician experience, preferably in a managed care environment.
• Medicare and/or Medicaid experience preferred.
• Experience in a dispensing pharmacy environment, such as retail, specialty, long-term care, or mail-order pharmacy.
• Prior experience using analysis tools or systems (e.g., web-based, custom, proprietary, etc.).
• Experience in the implementation of quality process improvement efforts.
• Experience documenting requirements, creating training materials, and working directly with end users.

Skills

• Strong attention to detail, analytical thinking, and organizational skills.
• Ability to collaborate effectively in a team-oriented environment while managing multiple priorities.
• Proficiency with Microsoft Office applications, including Word, Excel, PowerPoint, and Outlook.
• Excellent verbal and written communication skills with members, providers, pharmacies, and internal stakeholders.
• Positive attitude and interest in fraud, waste, and abuse prevention, compliance, and program integrity.

Qualifications

Current state's Pharmacy Technician license preferred.

Schedule

Monday–Friday, 8:00 AM – 4:30 PM. Eastern or Central time, with a 30-minute lunch.

Pay

Pay Range: $19.43 - $32.98 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

• Competitive pay
• Health insurance
• 401K and stock purchase plans
• Tuition reimbursement
• Paid time off plus holidays
• Flexible approach to work with remote, hybrid, field, or office work schedules

Benefits may be subject to program eligibility.