Director, Clinical Systems Operations (Pharmacy)

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 system design and requirements gathering
• Provide direction and guidance to various business functions to ensure systems meet business expectations and alignment with standard solutions and processes
• Evaluate systems and programs performance, recommend improvement opportunities and implement changes
• Oversee the implementations of new clinical systems and upgrades and modifications of existing clinical systems
• Oversee the investigation and resolutions of issues of all clinical systems
• Able to travel up to 30% of the time

Education/Experience: Bachelor's degree in Nursing, Computer Science, Business Administration, MIS or clinical related field or equivalent experience. 7+ years of applications, project management, or implementation experience. Previous management experience including responsibilities for hiring, training, assigning work and managing performance of staff. Prior ownership of clinical applications and clinical systems operations leadership, highly 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