Remote Prior Authorization Pharmacist — PBM & DUR Expert

Elevance Health; Leawood (KS); Hybrid; USD 110,000 - 150,000; Full time

Job summary

Elevance Health is seeking a Prior Authorization Clinical Pharmacist to support pharmaceutical utilization, safety and cost efficiency. This remote/hybrid role focuses on clinical data synthesis, drug information services and formulary management within a managed care framework.

The role emphasizes collaboration with clinicians, network physicians and the Pharmacy & Therapeutics Committee to optimize therapeutic outcomes and ensure appropriate coverage decisions across programs.

Qualifications

• Requires BA/BS in Pharmacy and an active pharmacist license.
• Minimum 2 years of managed care pharmacy (PBM) experience or residency.
• Licensure as Pharmacist in applicable state(s).
• For Puerto Rico roles, PR health and PR Law 300 certificates may be required.

Responsibilities

• Evaluate and manage selection and utilization of medications to ensure safe, effective use.
• Support Drug Utilization Review, Drug Information Services and formulary management.
• Review and determine coverage decisions based on medical necessity and program contracts.
• Provide clinical guidance on dose conversions and therapeutic interventions.
• Prepare information and drug monographs for network physicians and P&T Committee.

Skills

Clinical data synthesis

Medical necessity assessment

Clinical pharmacology guidance

Interdisciplinary collaboration

Drug information

Education

Bachelor of Pharmacy (BA/BS)

Licensed Pharmacist

Tools

Drug Utilization Review (DUR)

Drug Information Services (DIS)

Formulary management

Job description

Elevance Health is seeking a Prior Authorization Clinical Pharmacist to support pharmaceutical utilization, safety and cost efficiency. This remote/hybrid role focuses on clinical data synthesis, drug information services and formulary management within a managed care framework.

The role emphasizes collaboration with clinicians, network physicians and the Pharmacy & Therapeutics Committee to optimize therapeutic outcomes and ensure appropriate coverage decisions across programs.