Easy JobDirector, Clinical Systems Operations (Pharmacy)
Centene Corporation · Worldwide · Full-time · Remote
Position Purpose: Oversee the development, implementation, and operation of medical management information systems and/or new technology solutions to meet Corporate, Health Plan, and Specialty business unit needs.
Key Details: This is a remote Director, Clinical Systems Operations (Pharmacy) opportunity supporting Eastern or Central business hours. The team will consist of 11 individuals, including 4 direct reports. This role will lead Clinical Systems for the Pharmacy team, coordinating 50+ clinical program and initiative workflows across various business rules and overseeing 10,000+ programmed communications to members, providers, and pharmacies, with an annual volume of more than 8 million. Responsibilities include managing the systems that support direct clinical interactions with members and other clinical program activities; providing business rules for clinical data informatics to identify populations and medication-related problems by linking eligibility, medical, and pharmacy claims data across large data sets; and managing program triage to pharmacists and technicians based on program type, language, and state board of pharmacy licensure rules. The role will oversee system documentation and enhancements, business cases and business requirements, regulatory programming and reporting requirements, software defects, new feature implementation, vendor activities, system integrations, and User Acceptance Testing (UAT), while partnering closely with IT to support system and program needs. Desired experience includes prior direct ownership and management of clinical applications, as well as clinical systems operations leadership, pharmacy or managed care operations, regulatory compliance and reporting, vendor management, healthcare technology platform management, workflow and process optimization, and cross-functional leadership.
• Oversee the development and functionality of clinical systems and programs to improve efficiency and effectiveness, including syste