Clinical Pharmacist- Medicaid Custom Criteria Management
Elevance Health

Job Info

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Title: Clinical Pharmacist

Location: Candidates will work a Hybrid schedule and must reside within 50 miles or 1-hour commute each way of a relevant Elevance Health location.

Build the Possibilities. Make an Extraordinary Impact.

The Clinical Pharmacist is responsible for managing the selection and utilization of pharmaceuticals and supports core clinical programs such as DUR, DIS and formulary management.

How you will make an impact:

Primary duties may include, but are not limited to:

• Researches and synthesizes detailed clinical data related to pharmaceuticals.
  
• Prepares information for network physicians.
  
• Prepares and implements custom medical necessity criteria for Medicaid business to meet State contract requirements
  
• Support the health plan approval, oversight and annual review of custom criteria as needed
  
• Serves as a clinical resource to other pharmacists to introduce efficiencies or improved criteria documents based on claims issues, complaints, state recommendations or audits.
  
• Coordinates with internal stakeholders or health plan medical directors as needed
  

Minimum Requirements:

• 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.
  
• Must possess an active unrestricted state license to practice pharmacy as a Registered Pharmacist (RPh).
  
• Unless expressly allowed by state or federal law, or regulation, must be located in a state or territory of the United States when conducting utilization review or an appeals consideration and cannot be located on a US military base, vessel or any embassy located in or outside of the US, unless they are command-sanctioned activities.
  
• For URAC accredited areas, the following professional competencies apply: Associates in this role are expected to have strong oral, written and interpersonal communication skills, problem-solving skills, facilitation skills, and analytical skills.
  

Preferred Skills, Capabilities and Experiences:

• PharmD preferred.
  
• Managed Care Experience specific to formulary, Pharmacy and Therapeutics Committee, or clinical utilization management criteria development
  
• Experience in working with government agency policies. Medicaid preferred.
  
• Proficiency in MS excel, Outlook, Word, Adobe
  
• Proficiency in project management, handling multiple tasks and various timelines
  
• Must demonstrate proficiency in clinical/technical communication to business leaders, an ability to communicate messages pertaining to programs and systems using data and other details in a way business leaders can understand
  

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