Clinical Pharmacist - Prior Authorization

Elevance Health; Mason (OH); Remote; USD 80,000 - 100,000; Full time

Job summary

Join a dynamic team as a Clinical Pharmacist, where you'll play a vital role in managing pharmaceuticals and supporting clinical programs. This remote position offers an opportunity to impact patient care positively by ensuring effective medication utilization and adherence. You'll engage in research, present therapeutic reviews, and collaborate with healthcare professionals to enhance patient outcomes. If you're passionate about pharmacy and committed to improving health, this role in a forward-thinking organization is perfect for you.

Qualifications

• Requires BA/BS in Pharmacy and active unrestricted state license.
• Minimum 2 years of managed care pharmacy experience or residency.

Responsibilities

• Manage selection and utilization of pharmaceuticals.
• Research and synthesize clinical data related to medications.

Skills

Clinical Data Research

Communication Skills

Problem-Solving Skills

Analytical Skills

Education

BA/BS in Pharmacy

PharmD

Job description

Be Part of an Extraordinary Team

CarelonRx Pharmacy is now part of CarelonRx (formerly IngenioRx), a proud member of the Elevance Health family of companies. The CarelonRx Home Delivery Pharmacy will deliver a digital first pharmacy experience that is convenient, simpler to use, and more affordable for our patients and payors. Our Pharmacy model focuses on whole person care, providing the best member experience to drive adherence, affordability, and improved overall health outcomes by putting the patient first.

Title: Clinical Pharmacist

Location: Remote position

Candidates must reside within 50 miles or 1-hour commute each way of a relevant pulse point location.

Schedule: Monday-Friday, 8:30am - 5:00pm (rotating weekends)

The Clinical Pharmacist 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:
Primary duties may include, but are not limited to:

• 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.

Minimum Requirements:

• 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 Skills, Capabilities and Experiences:

• Active license for Indiana and South Carolina highly preferred.
• PharmD preferred.

For URAC accredited areas, the following professional competencies apply: Associates in this role are expected to have strong oral, written and interpersonal communication skills, problem-solving skills, facilitation skills, and analytical skills.