Remote Prior Authorization Pharmacist – Clinical & DUR Expert

Elevance Health; Nashville (TN); Remote; USD 90,000 - 140,000; Full time

Job summary

Elevance Health is seeking a Prior Authorization Clinical Pharmacist to evaluate and manage pharmaceutical utilization, ensuring safe, effective and cost-efficient care.

The role supports Drug Utilization Review, Drug Information Services, and formulary management, with virtual full-time work and required in-person training sessions. A licensed Pharmacist with PBM experience is preferred.

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.
• 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.

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.
• 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.

Skills

DUR

Drug Information

Formulary management

PBM experience

Clinical pharmacology

Pharmacist license

Education

BA/BS in Pharmacy

Job description

Elevance Health is seeking a Prior Authorization Clinical Pharmacist to evaluate and manage pharmaceutical utilization, ensuring safe, effective and cost-efficient care.

The role supports Drug Utilization Review, Drug Information Services, and formulary management, with virtual full-time work and required in-person training sessions. A licensed Pharmacist with PBM experience is preferred.