Clinical Pharmacist (Formulary & Quality)

Position Purpose: Define and develop standard and custom formularies for assigned plan.

Key Details: Indiana Clinical Pharmacist (Formulary & Quality). This is a remote opportunity for an Indiana-licensed Pharmacist working Monday through Friday on a daytime Eastern Time schedule. There are two open Clinical Pharmacist positions that support Indiana Medicaid pharmacy operations through either a Formulary & Policy focus or a Quality & Clinical Programs focus, with opportunities for collaboration and cross-coverage between the roles. Responsibilities include leading formulary, prior authorization, and clinical policy initiatives; supporting quality improvement and medication-related clinical programs; analyzing pharmacy and performance data; developing policies, workflows, educational materials, and communications; and partnering with cross-functional teams, providers, and vendors to implement state-driven and quality-focused initiatives. The ideal candidate will have experience in managed care, Medicaid, health plans, PBMs, formulary management, prior authorization, quality improvement, specialty drug management and/or population health and demonstrate strong clinical judgment, written communication, project management, data analysis, and collaboration skills. Success in this role requires the ability to manage competing priorities, translate complex requirements into actionable solutions, identify risks, and consistently deliver accurate, audit-ready work. This opportunity offers meaningful ownership, visibility, and the chance to directly impact member access, medication safety, quality outcomes, and regulatory compliance within Indiana Medicaid pharmacy programs.

• Develop clinical criteria for medications, recommend plan design changes, and clinical programs to be initiated
• Monitor prior authorization requests
• Provide clinical support to internal departments and address clinical related questions
• Ensure appropriate quality controls and initiates opportunities for performance improvement in pharmacy/practice
• Develop and implement programs designed to impact DUR for both Medicaid and Medicare
• Develop, implement, and maintain policies and procedures for the pharmacy department
• Participate in the coordination of the Medicare MTM program
• Assist case management team with members including clinical rounds presentations

Education/Experience: Bachelor’s degree or advanced degree (Pharm.D., M.S.) in pharmacy. 2+ years of mail order, retail, hospital or managed care pharmacy experience or 1+ years of pharmacy residency program experience. Specialty drug management experience, preferred

Licenses/Certifications: Current Indiana Pharmacist license with no restrictions.

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