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About the Role
The Pharmacist Clinical (Oncology focused) is responsible for managing the selection and utilization of pharmaceuticals and supports core clinical utilization management programs such as prior authorization, step therapy, and quantity limitations. This role ensures clinical criteria are implemented correctly by working with operational areas.
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.
- Reviews and approves or denies coverage for pharmaceuticals based on medical necessity criteria, coordinating with health plan medical directors as needed.
- Leads development and maintenance of clinical criteria for drugs processed on the pharmacy and medical benefits.
- Researches and synthesizes high-quality clinical evidence related to drug and biologic efficacy and safety.
- Reviews clinical evidence and guideline recommendations to create and maintain clinical criteria for appropriate, cost-effective drug therapy.
- Prepares and presents drug clinical criteria through quarterly Pharmacy and Therapeutics (P&T) Process.
- Works with clinical operations teams to ensure appropriate claims system set-up and clinical review algorithms for P&T approved edits.
- Presents and collaborates with internal stakeholders, including medical directors, pharmacists, nurses, and business area leads.
- Provides drug information support to internal stakeholders.
- Serves as a clinical pharmacy resource to pharmacy account management and trend management teams.
- Ensures compliance of pharmacy utilization management edits with state and federal mandates and contractual agreements.
- Provides support for drug pipeline monitoring and evaluation.
Requirements
- 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.
- Must possess an active unrestricted state license to practice pharmacy as a Registered Pharmacist (RPh).
Skills
- Cross-mapping clinical codes
- Optimizing drug-utilization screening rules
- Validating clinical data accuracy using the Medi-Span database
Location
- California
- Virginia
- New Jersey
- Columbus Ohio
- Illinois
- Nevada
Work Type
- Hybrid
- 1-2 days per week in-office
Experience Level
- Non-Management Exempt
- Minimum of 2 years of managed care pharmacy (PBM) experience or residency
Education Level
- BA/BS in Pharmacy
- PharmD preferred
- Residency preferred
Salary/Compensations
- $119,360 to $214,848
Benefits
- Comprehensive benefits package
- Incentive and recognition programs
- Equity stock purchase
- 401k contribution
- Merit increases
- Paid holidays
- Paid Time Off
- Incentive bonus programs
- Medical
- Dental
- Vision
- Short and long term disability benefits
- 401(k) +match
- Stock purchase plan
- Life insurance
- Wellness programs
- Financial education resources
About the Company
- Elevance Health is a health company dedicated to improving lives and communities – and making healthcare simpler.
- A Fortune 25 company with a longstanding history in the healthcare industry.
- Creating a culture designed to advance strategy and foster personal and professional growth.
- Values and behaviors are the root of our culture, driving shared success.
Equal Opportunity
- Elevance Health is an Equal Employment Opportunity employer, and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws.
- Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state, and local laws, including, but not limited to, the Los Angeles County Fair Chance Ordinance and the California Fair Chance Act.
- Prospective employees required to be screened under Florida law should review the education and awareness resources at HB531 | Florida Agency for Health Care Administration.