Clinical Pharmacist - Hybrid, Utilization & P&T Expert

Elevance Health; Cincinnati (OH); Hybrid; USD 119,000 - 215,000; Full time

Benefits offered by this job

Hybrid work model

Equal employment opportunity

Job summary

Elevance Health is seeking a Pharmacist Clinical to lead clinical utilization management, including prior authorization and step therapy, with a hybrid work arrangement. The role emphasizes collaboration with clinical operations to implement criteria and with internal stakeholders such as medical directors and pharmacists across multiple locations including Columbus, OH.

The candidate should hold a BA/BS in Pharmacy, be a registered pharmacist, and have 2 years of PBM or residency experience;

Qualifications

• Requires BA/BS in Pharmacy and an active state RPh license.
• Minimum 2 years of managed care pharmacy experience or residency in lieu of work experience.
• PharmD degree preferred; residency with P&T preferred.
• Experience cross-mapping clinical codes and using Medi-Span database is highly preferred.

Responsibilities

• Researches and synthesizes detailed clinical data related to pharmaceuticals.
• Prepares therapeutic class reviews and drug monographs for the P&T committee.
• Serves as clinical resource on DURs and provides dosage conversion support.
• Develops and maintains clinical criteria for drugs processing on POS edits.
• Ensures clinical evidence supports POS edits for prior authorization, step therapy, and quantity limits.
• Collaborates with medical directors, pharmacists, nurses and business leads.

Skills

PBM experience

Clinical pharmacy

Cross-mapping clinical codes

Education

BA/BS in Pharmacy

Tools

Medi-Span database

Job description

Elevance Health is seeking a Pharmacist Clinical to lead clinical utilization management, including prior authorization and step therapy, with a hybrid work arrangement. The role emphasizes collaboration with clinical operations to implement criteria and with internal stakeholders such as medical directors and pharmacists across multiple locations including Columbus, OH.

The candidate should hold a BA/BS in Pharmacy, be a registered pharmacist, and have 2 years of PBM or residency experience;