"Alerted.org

You could be the one who changes everything for our 28 million members as an Intern at Centene. During this 12-week program, you'll learn more about Centene and how we're transforming the health of the community, one person at a time.

**Position Purpose:** This intern will support the efforts of the Medical Pharmacy Quality Assurance team by assisting with clinical review and quality assurance activities related to prior authorizations and appeals. The role includes evaluating documentation, identifying trends and errors, supporting audit readiness, and gaining exposure to regulatory requirements.

Duties:

+ Evaluate prior authorization requests by reviewing clinical criteria, chart notes, and claims data, and documenting evidence-based rationales for approval or denial.

+ Participate in QA reviews of Medical Pharmacy and Organization Determination prior authorizations and appeals; document findings, analyze trends, and make recommendations.

+ Contribute to projects focused on identifying decision-making patterns, financial impacts of incorrect decisions, and error trends across drugs and lines of business.

+ Assist in preparing for CMS, NCQA, and state-specific audits by ensuring documentation accuracy and regulatory compliance.

+ Gain familiarity with the PDAC process and its role in clinical and reimbursement decisions.

+ Develop a working knowledge of state-specific healthcare requirements including IRR protocols, PDLs, New York EDVS, EPSDT, coverage exclusions, continuity of care, retroactive reviews, out-of-network provider rules, licensure standards, and site-of-care policies.

Qualifications:

+ Currently enrolled in an accredited Doctor of Pharmacy (PharmD) program.

+ Strong interest in managed care, clinical auditing, and regulatory compliance.

+ Detail-oriented with good communication and organizational skills.

+ Ability to work independently and collaboratively in a professional environment.

**Education/Experience:** Bachelor’s degree or equivalent undergraduate coursework completed. Must be enrolled in a Pharmacy graduate program at an accredited university or college in a field related to the hiring department through the internship period.

This role will allow you to work fully remote in the US.

Pay Range: $21-30/hour

Centene offers a comprehensive benefits package including competitive pay, health insurance, 401(k) 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