Clinical Pharmacist – Utilization & P&T Expert (Hybrid)

Elevance Health; Woodbridge Township (NJ); Hybrid; USD 119,000 - 215,000; Full time

Job summary

Elevance Health is looking for a Pharmacist Clinical to join our hybrid team in the United States. The role concentrates on clinical utilization management, including prior authorization, step therapy, and quantity limits, while ensuring accurate implementation with operational partners.

You will research and synthesize detailed clinical data on pharmaceuticals, present drug monographs to the Pharmacy and Therapeutics Committee, and serve as a clinical resource across inpatient and outpatient

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

Responsibilities

• 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.
• 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.
• Lead development and maintenance of clinical criteria for drugs that process on the pharmacy and medical benefits (clinical utilization management edits).
• Researches and synthesizes high quality clinical evidence related to the efficacy and safety of drugs and biologics.
• Reviews clinical evidence and guideline recommendations to create and maintain clinical criteria (clinical utilization management edits) that ensure members receive appropriate, cost effective drug therapy.
• Prepares and presents drug clinical criteria through quarterly Pharmacy and Therapeutics (P&T) Process.
• Works with the clinical operations teams to ensure appropriate claims system set-up and clinical review algorithms are in place for P&T approved point of sale edits.
• Presents and collaboration with internal stakeholders (medical directors, pharmacists, nurses, business area leads, etc.).
• Provides drug information support to internal stakeholders as needed.
• Serves as a clinical pharmacy resource to pharmacy account management and trend management teams.
• Ensures compliance of pharmacy utilization management edits in accordance with state and federal mandates and contractual agreements.
• Drug pipeline monitoring and evaluation support.

Skills

Managed care pharmacy

Clinical data synthesis

Clinical utilization management

Education

BA/BS in Pharmacy

PharmD preferred

Residency (P&T) preferred

Tools

Medi-Span database

Job description

Elevance Health is looking for a Pharmacist Clinical to join our hybrid team in the United States. The role concentrates on clinical utilization management, including prior authorization, step therapy, and quantity limits, while ensuring accurate implementation with operational partners.

You will research and synthesize detailed clinical data on pharmaceuticals, present drug monographs to the Pharmacy and Therapeutics Committee, and serve as a clinical resource across inpatient and outpatient