Position Purpose: Manage the triage process of prior authorizations, including supervising pharmacy technicians, manage departmental work flow; identify and develop prior authorization procedures and policies.

Key Details: Must be authorized to work in the U.S. without the need for employment-based visa sponsorship now or in the future. Sponsorship and future sponsorship are not available for this opportunity, including employment-based visa types H-1B, L-1, O-1, H-1B1, F-1, J-1, OPT, or CPT.

• Coordinate with various departments to research and resolve escalated complaints and inquiries
• Monitor prior authorization processes and recommend and modify current policies and procedures
• Ensure operational integrity, including compliance with all associated policies and procedures
• Monitor prior authorization activities and determine appropriate staffing levels
• Oversee department performance and review reports and audit findings to ensure optimal performance is achieved
• Ensure provider notification letters are communicated accurately and in a timely manner
• Oversee quality control checks and provide recommendations for improvement
• Communicate with providers and pharmacies to advise clinical outcome of prior authorization request
• Oversee multiple pharmacy systems to track and triage prior authorization requests for Medicaid and coverage determination requests for Medicare D recipients and determine if a pharmacist review is required

Education/Experience: Associates degree in related field or equivalent experience. 4+ years of pharmacy technician experience in a mail order prescription facility, hospital pharmacy or retail pharmacy setting. 1+ years of combined lead or supervisory and customer service experience.

License/Certification: Current state’s Pharmacy Technician license and National Certification from Pharmacy Technician Certification Board (CPhT) preferred.

 

At Centene, we connect people to the care they need to live healthier lives — and the work you do here makes that impact real every day. You’ll take on meaningful challenges that directly support individuals, families, and communities, building your skills while making healthcare more accessible and effective. It’s work with a purpose you can see, backed by a team committed to improving lives well beyond the workday.
 

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, including full-time or part-time status.  Total compensation may also include additional forms of incentives. Benefits may be subject to program eligibility.

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.

Qualified applicants with arrest or conviction records will be considered in accordance with the LA County Ordinance and the California Fair Chance Act