Clinical Pharmacist - Prior Authorization

Elevance Health; Lowes Grove (NC); Hybrid; USD 120,000 - 150,000; Full time

Job summary

Elevance Health is seeking a Pharmacist Clinical with active license in North Carolina or Kansas. This virtual-eligible role allows remote work with required in-person training and occasional onsite days within a reasonable distance of Elevance Health offices.

The Clinical Pharmacist (Prior Authorization) will manage pharmaceutical selection, support DUR, DIS and formulary programs, and review coverage based on medical necessity, collaborating with health plan medical directors as needed.

Qualifications

• Requires BA/BS in Pharmacy.
• Minimum of 2 years of managed care pharmacy experience or residency.
• Requires a registered pharmacist and active state license to practice.
• For Puerto Rico associates, PR health certificate and PR Law 300 certificate required.
• Licensure in Kansas or North Carolina preferred.

Responsibilities

• Researches and synthesizes detailed clinical data related to pharmaceuticals.
• Prepares and presents therapeutic class reviews and drug monographs to the Pharmacy and Therapeutics Committee.
• May review and approve or deny coverage for pharmaceuticals based on medical necessity criteria.
• Serves as a clinical resource to other pharmacists on prospective, inpatient and retrospective DURs and provides dosage conversion.
• Prepares information for network physicians.

Skills

Communication skills

Problem solving

Analytical skills

Interpersonal skills

Pharmaceutical care

Education

BA/BS in Pharmacy

PharmD preferred

Job description

Pharmacist Clinical

****Seeking Pharmacists who are licensed in North Carolina or Kansas!****

LOCATION: This position is virtual eligible. You should be within a reasonable distance of one of our offices.

HOURS: General business hours, Monday through Friday

Virtual: This role enables associates to work virtually full-time, with the exception of required in-person training sessions, providing maximum flexibility and autonomy. This approach promotes productivity, supports work-life integration, and ensures essential face-to-face onboarding and skill development.

Please note that per our policy on hybrid/virtual work, candidates not within a reasonable commuting distance from the posting location(s) will not be considered for employment, unless an accommodation is granted as required by law.

The Clinical Pharmacist (Prior Authorization) is responsible for managing the selection and utilization of pharmaceuticals and supports core clinical programs such as DUR, DIS and formulary management.

How you will make an impact:

• Researches and synthesizes detailed clinical data related to pharmaceuticals.




• Prepares and presents therapeutic class reviews and drug monograph information to the Pharmacy and Therapeutics Committee.




• May review and approve or deny coverage for pharmaceuticals (as permitted by state/federal law or state/federal program contracts) based on medical necessity criteria, and coordinates with internal stakeholders or health plan medical directors as needed.




• Serves as a clinical resource to other pharmacists on areas such as prospective, inpatient and retrospective DURs and provides dosage conversion and clinical support for therapeutic interventions.




• Prepares information for network physicians.

Required Qualifications

• Requires BA/BS in Pharmacy.




• Minimum of 2 years of managed care pharmacy (PBM) experience or residency in lieu of work experience; or any combination of education and experience, which would provide an equivalent background.




• Requires a registered pharmacist.




• Must possess an active unrestricted state license to practice pharmacy as a Registered Pharmacist (RPh).




• For associates working within Puerto Rico who are member or patient facing either in a clinical setting or in the Best Transportation unit, a current PR health certificate and a current PR Law 300 certificate are required for this position.

Preferred Qualifications

• PharmD very strongly preferred.




• You must be licensed in Kansas or North Carolina.




• Associates in this role are expected to have strong oral, written and interpersonal communication skills, problem-solving skills, facilitation skills, and analytical skills.

Please be advised that Elevance Health only accepts resumes for compensation from agencies that have a signed agreement with Elevance Health. Any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of Elevance Health.

Who We Are

Elevance Health is a health company dedicated to improving lives and communities – and making healthcare simpler. We are a Fortune 25 company with a longstanding history in the healthcare industry, looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve.

How We Work

At Elevance Health, we are creating a culture that is designed to advance our strategy but will also lead to personal and professional growth for our associates. Our values and behaviors are the root of our culture. They are how we achieve our strategy, power our business outcomes and drive our shared success - for our consumers, our associates, our communities and our business.

We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few.

Elevance Health operates in a Hybrid Workforce Strategy. Unless specified as primarily virtual by the hiring manager, associates are required to work at an Elevance Health location at least once per week, and potentially several times per week. Specific requirements and expectations for time onsite will be discussed as part of the hiring process.

The health of our associates and communities is a top priority for Elevance Health. We require all new candidates in certain patient/member-facing roles to become vaccinated against COVID-19 and Influenza. If you are not vaccinated, your offer will be rescinded unless you provide an acceptable explanation. Elevance Health will also follow all relevant federal, state and local laws.

Elevance Health is an Equal Employment Opportunity employer and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws. Applicants who require accommodation to participate in the job application process may contact [e-mail] for assistance.

Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state, and local laws, including, but not limited to, the Los Angeles County Fair Chance Ordinance and the California Fair Chance Act.

Prospective employees required to be screened under Florida law should review the education and awareness resources at HB531 | Florida Agency for Health Care Administration.