Remote Clinical Pharmacist - Prior Authorization

Elevance Health; Topeka (KS); Hybrid; USD 110,000 - 140,000; Full time

Job summary

Elevance Health is seeking a Pharmacist Clinical (Prior Authorization) licensed in Kansas or North Carolina. The role supports clinical programs and manages pharmaceutical selections with emphasis on DUR, DIS and formulary management.

Virtual eligibility with occasional in-person training, and a proximity requirement to a local office. Responsibilities include researching clinical data on pharmaceuticals, presenting reviews to the Pharmacy and Therapeutics Committee, reviewing coverage

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.
• 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.

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 (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.

Education

BA/BS in Pharmacy

Job description

Elevance Health is seeking a Pharmacist Clinical (Prior Authorization) licensed in Kansas or North Carolina. The role supports clinical programs and manages pharmaceutical selections with emphasis on DUR, DIS and formulary management.

Virtual eligibility with occasional in-person training, and a proximity requirement to a local office. Responsibilities include researching clinical data on pharmaceuticals, presenting reviews to the Pharmacy and Therapeutics Committee, reviewing coverage