Remote Clinical Pharmacist – Prior Authorization

The Elevance Health Companies, Inc.; Lowes Grove (NC); Hybrid; USD 110,000 - 150,000; Full time

Benefits offered by this job

Medical

Dental

Vision

401(k) + match

Job summary

Elevance Health is seeking a Clinical Pharmacist - Prior Authorization to manage pharmaceutical utilization and support core clinical programs. The role is virtual eligible with in-person training, requiring NC or KS licensure and a Doctoral or Bachelors in Pharmacy.

You will synthesize data, present drug monographs, and assist coverage decisions while collaborating with medical directors and physicians across networks.

Qualifications

• 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.
• 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.

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.
• May review and approve or deny coverage for pharmaceuticals 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.

Skills

Communication skills

Interpersonal skills

Pharmacist license

Education

BA/BS in Pharmacy

PharmD preferred

Job description

Elevance Health is seeking a Clinical Pharmacist - Prior Authorization to manage pharmaceutical utilization and support core clinical programs. The role is virtual eligible with in-person training, requiring NC or KS licensure and a Doctoral or Bachelors in Pharmacy.

You will synthesize data, present drug monographs, and assist coverage decisions while collaborating with medical directors and physicians across networks.