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. position details *qualified candidates must be available to work 10am – 6:30pm est monday-friday* position purpose: the senior pharmacy resolution specialist acts as a subject matter expert, handling complex pharmacy issues and responding to escalated calls from members, provider/physician offices, and pharmacies. this role involves making outbound calls and entering pharmacy overrides into systems based on approved guidelines and approvals from clinical pharmacists. key responsibilities: 1. takes member/prescriber/pharmacist inquiry calls for benefit questions, including prior authorization requests. 2. offers options including submission of a prior authorization request. 3. researches issues thoroughly and takes appropriate actions to resolve them within turnaround time requirements and quality standards. 4. answers and conducts inbound and outbound calls with members and provider offices to resolve claims issues, such as additional information requests and medication determination updates. 5. guides team members in resolving complex inquiries and participates in training less experienced staff, including job shadowing opportunities. 6. acts as a liaison between internal departments for data gathering and problem solving, especially for unusual issues. 7. presents proposed solutio...
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. position details *qualified candidates must be available to work 10am – 6:30pm est monday-friday* position purpose: the senior pharmacy resolution specialist acts as a subject matter expert, handling complex pharmacy issues and responding to escalated calls from members, provider/physician offices, and pharmacies. this role involves making outbound calls and entering pharmacy overrides into systems based on approved guidelines and approvals from clinical pharmacists. key responsibilities: takes member/prescriber/pharmacist inquiry calls for benefit questions, including prior authorization requests. offers options including submission of a prior authorization request. researches issues thoroughly and takes appropriate actions to resolve them within turnaround time requirements and quality standards. answers and conducts inbound and outbound calls with members and provider offices to resolve claims issues, such as additional information requests and medication determination updates. guides team members in resolving complex inquiries and participates in training less experienced staff, including job shadowing opportunities. acts as a liaison between internal departments for data gathering and problem solving, especially for unusual issues. presents proposed solutions clearly an...
Cree una alerta de empleo y reciba nuevas ofertas que se adaptan a su perfil desde más de 2550 sitios web de empleo