Clinical Audit Coordinator (Pharmacy)

You could be the one who changes everything for our 28 million members. Centene is transforming the health of our communities, one person at a time. As a diversified, national organization, you’ll have access to competitive benefits including a fresh perspective on workplace flexibility.
 

Clinical Audit Coordinator (Pharmacy)

Must have pharmacy experience with Compass, TruCare, or CareCentral.

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. If you are a licensed pharmacy technician who enjoys problem-solving, analyzing trends, improving processes, and collaborating across teams, this role offers the opportunity to make a meaningful impact beyond traditional pharmacy operations.

Job specific Details

• 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

​ Working shift: 9:30am - 6pm (Eastern / EST)

Position Purpose: 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

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

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