Remote Prior Authorization Pharmacist | Managed Care Expert

Elevance Health; United States; Remote; USD 119,000 - 206,000; Full time

Benefits offered by this job

Comprehensive benefits package

Incentive and recognition programs

Equity stock purchase

401k contribution

Job summary

Elevance Health is seeking a Prior Authorization Clinical Pharmacist to evaluate and manage pharmaceutical utilization, supporting DUR, DIS, and formulary management. The role may involve virtual full-time work with required in-person training, and occasional office-based location access within commuting distance.

The ideal candidate holds a BA/BS in Pharmacy and a valid pharmacist license with at least 2 years of managed care PBM experience.

Qualifications

• Requires BA/BS in Pharmacy.
• Minimum of 2 years of managed care pharmacy (PBM) experience or residency in lieu of work experience.
• Requires a registered pharmacist with an unrestricted license.
• For associates in Puerto Rico: PR health and PR Law 300 certificates if applicable.

Responsibilities

• Evaluates and manages selection and utilization of pharmaceuticals for safe, effective use.
• Supports Drug Utilization Review, Drug Information Services, and formulary management.
• Reviews coverage for pharmaceuticals based on medical necessity criteria with internal partners.
• Serves as clinical resource on DURs and provides dosage conversions and interventions.
• Prepares and presents drug information to network physicians and P&T committees.
• Provides evidence-based recommendations for therapeutic interventions.

Skills

PBM experience

Prior Authorization

Clinical pharmacy

DUR knowledge

Education

BA/BS in Pharmacy

Pharmacist license

Job description

Elevance Health is seeking a Prior Authorization Clinical Pharmacist to evaluate and manage pharmaceutical utilization, supporting DUR, DIS, and formulary management. The role may involve virtual full-time work with required in-person training, and occasional office-based location access within commuting distance.

The ideal candidate holds a BA/BS in Pharmacy and a valid pharmacist license with at least 2 years of managed care PBM experience.