Virtual Clinical Pharmacist — Prior Authorization Expert

The Elevance Health Companies, Inc.; Overland Park (KS); Hybrid; USD 120,000 - 180,000; Full time

Benefits offered by this job

Health insurance

Paid time off

401(k) + match

Stock purchase plan

Wellness programs

Merit increases

Dental

Vision

Life insurance

Job summary

Elevance Health seeks a Prior Authorization Clinical Pharmacist to evaluate and manage pharmaceutical use, ensuring safe, effective, and cost-efficient therapy. This virtual-full-time role supports DUR, DIS, and formulary programs while aligning with hybrid work policies and in-person onboarding as required.

Responsibilities include presenting reviews to P&T committees, providing clinical guidance to pharmacists, and coordinating with health plan stakeholders.

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 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 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

Prior authorization experience

PBM experience

Clinical pharmacology knowledge

Residency in lieu of work experience

Education

BA/BS in Pharmacy

PharmD preferred

Job description

Elevance Health seeks a Prior Authorization Clinical Pharmacist to evaluate and manage pharmaceutical use, ensuring safe, effective, and cost-efficient therapy. This virtual-full-time role supports DUR, DIS, and formulary programs while aligning with hybrid work policies and in-person onboarding as required.

Responsibilities include presenting reviews to P&T committees, providing clinical guidance to pharmacists, and coordinating with health plan stakeholders.