Prior Authorization Clinical Pharmacist

🔥 0 minutes ago

🐊 Florida, Kansas, +4 more states – Remote

🐊 Florida – Remote 🌪️ Kansas – Remote 🐎 Kentucky – Remote 🌲 North Carolina – Remote 🎸 Tennessee – Remote 🤠 Texas – Remote

⏰ Full Time

🟢 Junior

🟡 Mid-level

💊 Pharmacist

🦅 H1B Visa Sponsor

This company has sponsored H1B visas in the past.

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Elevance Health

WebsiteLinkedInAll Job Openings

10,000+ employees

🏥 Healthcare

⚕️ Healthcare Insurance

🤝 B2B

Healthcare • Healthcare Insurance • B2B

Elevance Health is transforming from a traditional health benefits organization into a lifetime trusted health partner, driven by a bold purpose to improve the health of humanity. With nearly 100,000 associates, they serve over 118 million people and utilize an integrated whole health approach supported by industry-leading capabilities and a digital health platform. Their mission includes redefining health, reimagining the health system, and strengthening communities.

📋 Description

• Evaluate and manage the selection and utilization of pharmaceuticals • Ensure safe, effective, and cost-efficient medication use • Support Drug Utilization Review (DUR), Drug Information Services (DIS), and formulary management programs • Research and synthesize detailed clinical pharmaceutical data • Prepare and present therapeutic class reviews and drug monograph information to the Pharmacy and Therapeutics Committee • Review and approve or deny pharmaceutical coverage based on medical necessity criteria, as permitted by applicable law and contracts • Coordinate with internal stakeholders and health plan medical directors • Serve as a clinical resource to pharmacists on prospective, inpatient, and retrospective DURs • Provide dosage conversion and clinical support for therapeutic interventions • Prepare information for network physicians • Provide clinical guidance for therapeutic interventions, dosage conversions, and evidence-based medication use • Develop and communicate drug information and recommendations to network physicians and clinical teams

🎯 Requirements

• 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 providing an equivalent background • Registered pharmacist required • Current unrestricted Pharmacist license in applicable state(s) required • Must be located in a state or territory of the United States when conducting utilization review or appeals consideration, unless expressly allowed by state or federal law or regulation • Cannot be located on a US military base, vessel, or embassy for utilization review or appeals consideration unless conducting command-sanctioned activities • Strong oral, written, and interpersonal communication skills • Problem-solving skills • Facilitation skills • Analytical skills • Active, unrestricted RPh license in Kansas highly preferred • PharmD preferred • PBM experience preferred • Prior Authorization experience preferred • Specialty Medication experience preferred • COVID-19 and Influenza vaccination may be required for certain patient/member-facing roles

🏖️ Benefits

• Merit increases • Paid holidays • Paid Time Off • Incentive bonus programs • Medical benefits • Dental benefits • Vision benefits • Short-term disability benefits • Long-term disability benefits • 401(k) + match • Stock purchase plan • Life insurance • Wellness programs • Financial education resources • Virtual full-time work, except for required in-person training sessions • Maximum flexibility and autonomy