Prior Authorization Clinical Pharmacist

Elevance Health; Durham (NC); A distancia; USD 119.000 - 206.000; Jornada completa

Ventajas ofrecidas por este puesto de trabajo

Comprehensive benefits package

Equity stock purchase plan

401(k) contribution

Descripción de la vacante

Elevance Health is seeking a Prior Authorization Clinical Pharmacist to evaluate and manage pharmaceutical use, supporting Drug Utilization Review (DUR), Drug Information Services (DIS), and formulary management.

This full-time, virtual role requires a BA/BS in Pharmacy, a pharmacy license, and PBM experience. Preference for NC licensure and PharmD. In-person training sessions are required.

Formación

• Requires BA/BS in Pharmacy.
• Minimum of 2 years of managed care pharmacy (PBM) experience or residency in lieu of work experience.
• Requires a registered pharmacist and current unrestricted license in applicable state(s).
• For associates in PR/ Puerto Rico, PR health certificate and PR Law 300 certificate may be required.
• Strong oral, written and interpersonal communication skills; analytical abilities are essential.

Responsabilidades

• Researches and synthesizes detailed clinical data related to pharmaceuticals.
• Prepares therapeutic class reviews and drug monographs for 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 DURs and provides dosage conversions and clinical support.
• Develops and communicates drug information and recommendations to network physicians and clinical teams.

Conocimientos

Oral communication

Written communication

Interpersonal skills

Analytical skills

Clinical data analysis

Educación

BA/BS in Pharmacy

PharmD

Descripción del empleo

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. Alternate locations may be considered if candidates reside within a commuting distance from an office.

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.

Prior Authorization Clinical Pharmacist is responsible for evaluating and managing the selection and utilization of pharmaceuticals to ensure safe, effective, and cost-efficient medication use. This role supports key clinical pharmacy programs, including Drug Utilization Review (DUR), Drug Information Services (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.
• Prepares and presents therapeutic class reviews and drug monographs to the Pharmacy and Therapeutics (P&T) Committee.
• Provides clinical guidance for therapeutic interventions, dosage conversions, and evidence-based medication use.
• Develops and communicates drug information and recommendations to network physicians and clinical teams.

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.
• Current unrestricted Pharmacist license in applicable state(s) required.
• 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, unrestricted license to practice pharmacy as a Registered Pharmacist (RPh) in the states of North Carolina, and/or Washington highly preferred.
• PharmD preferred.
• PBM experience preferred.
• Prior Authorization experience preferred.
• Specialty Medication experience preferred.

Unless expressly allowed by state or federal law, or regulation, must be located in a state or territory of the United States when conducting utilization review or an appeals consideration and cannot be located on a US military base, vessel or any embassy located in or outside of the US, unless they are command-sanctioned activities.

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.

For candidates working in person or virtually in the below locations, the salary* range for this specific position is $119,360- to $205,896.

Locations:

Washington

In addition to your salary, Elevance Health offers benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). The salary offered for this specific position is based on a number of legitimate, non-discriminatory factors set by the company. The company is fully committed to ensuring equal pay opportunities for equal work regardless of gender, race, or any other category protected by federal, state, and local pay equity laws.

• The salary range is the range Elevance Health in good faith believes is the range of possible compensation for this role at the time of this posting. This range may be modified in the future and actual compensation may vary from posting based on geographic location, work experience, education, and/or skill level. Even within the range, the actual compensation will vary depending on the above factors as well as market/business considerations. No amount is considered to be wages or compensation until such amount is earned, vested, and determinable under the terms and conditions of the applicable policies and plans. The amount and availability of any bonus, commission, benefits, or any other form of compensation and benefits that are allocable to a particular employee remains in the Company's sole discretion unless and until paid and may be modified at the Company’s sole discretion, consistent with the law.