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Clinical Pharmacist
1 month ago
The Clinical Pharmacist - Prior Authorization Specialist will be responsible for managing the selection and utilization of pharmaceuticals and supporting core clinical programs such as DUR, DIS, and formulary management.
Key Responsibilities- Researches and synthesizes detailed clinical data related to pharmaceuticals.
- Reviews and approves or denies coverage for pharmaceuticals based on medical necessity criteria.
- Serves as a clinical resource to other pharmacists on areas such as prospective, inpatient, and retrospective DURs.
- Coordinates with Medical Directors and RNs in the UM Department, Providers.
- Provides evaluation of member's Rx needs and therapies through review of medication history.
- Ensures that providers understand appropriate use of current prescriptions.
- BA/BS in Pharmacy.
- Minimum of 2 years of managed care pharmacy (PBM) experience or residency in lieu of work experience.
- Registered pharmacist with an active unrestricted state license to practice pharmacy.
- PharmD preferred.
- Experience with direct patient counseling, provider interaction, and/or education preferred.
- Clinical Pharmacy experience strongly preferred.
Elevance Health is a health company dedicated to improving lives and communities. We are a Fortune 25 company with a longstanding history in the healthcare industry, looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve.
