Remote Prior Authorization Pharmacist — Clinical Expert

Elevance Health; Overland Park (KS); Hybrid; USD 120,000 - 150,000; Full time

Job summary

Elevance Health is seeking a Prior Authorization Clinical Pharmacist for virtual/hybrid work in the United States. The role focuses on evaluating pharmaceutical utilization to ensure safe, effective, and cost-efficient care, supporting DUR, DIS, and formulary management.

In-person training sessions are required, with alternate locations considered for commuting distance. The pharmacist will present drug monographs to the Pharmacy and Therapeutics Committee and may review coverage decisions based

Qualifications

• Requires BA/BS in Pharmacy and an active Pharmacist license.
• Minimum 2 years in managed care pharmacy (PBM) or residency-equivalent experience.
• Requires current, unrestricted Pharmacist license in the applicable state.

Responsibilities

• Evaluate and manage pharmaceutical selection and utilization for safety, efficacy, and cost efficiency.
• Support Drug Utilization Review (DUR), Drug Information Services (DIS), and formulary management.
• Review coverage decisions for pharmaceuticals based on medical necessity and coordinate with health plan medical directors.
• Serve as clinical resource for prospective, inpatient and retrospective DURs and provide dosage guidance.
• Prepare information for network physicians and present class reviews and monographs to P&T Committee.
• Provide evidence-based medication use guidance to clinical teams.

Skills

RPh licensed in Kansas

PBM experience

Prior Authorization experience

Education

BA/BS in Pharmacy

PharmD preferred

Job description

Elevance Health is seeking a Prior Authorization Clinical Pharmacist for virtual/hybrid work in the United States. The role focuses on evaluating pharmaceutical utilization to ensure safe, effective, and cost-efficient care, supporting DUR, DIS, and formulary management.

In-person training sessions are required, with alternate locations considered for commuting distance. The pharmacist will present drug monographs to the Pharmacy and Therapeutics Committee and may review coverage decisions based