Remote Prior Authorization Pharmacist, Clinical

Elevance Health

Louisville (KY)

Hybrid

USD 110,000 - 140,000

Full time

4 days ago

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Job summary

Elevance Health is hiring a Prior Authorization Clinical Pharmacist for a virtual role with occasional in-person training. The position focuses on evaluating drugs for safety, efficacy, and cost-efficiency, supporting Drug Utilization Review, Drug Information Services, and formulary management.

You will present to the Pharmacy and Therapeutics Committee, review coverage requests, and advise network physicians and clinical teams.

Qualifications

Requires BA/BS in Pharmacy.
Minimum of 2 years of managed care pharmacy (PBM) experience or residency in lieu of work experience; or equivalent background.
Requires a registered pharmacist.
Current unrestricted Pharmacist license in applicable state(s).
PR health certificate and PR Law 300 certificate if operating in Puerto Rico (where applicable).

Responsibilities

Evaluates and manages selection and utilization of pharmaceuticals for safe, effective, and cost-efficient use.
Researches and synthesizes detailed clinical data related to pharmaceuticals.
Prepares and presents drug monographs and therapeutic class reviews to the Pharmacy and Therapeutics Committee.
Reviews and may approve or deny coverage for pharmaceuticals based on medical necessity criteria.
Provides clinical guidance for interventions, dosage conversions, and evidence-based medication use.