Instagram
youtube
Facebook
10 Jan. 6, 2025
Job Description
Job Type: Full Time Education: BA/BS/PharmD Skills: Causality Assessment, Clinical SAS Programming, Communication Skills, CPC Certified, GCP guidelines, ICD-10 CM Codes, CPT-Codes, HCPCS Codes, ICD-10 CM, CPT, HCPCS Coding, ICH guidelines, ICSR Case Processing, Interpersonal Skill, Labelling Assessment, MedDRA Coding, Medical Billing, Medical Coding, Medical Terminology, Narrative Writing, Research & Development, Technical Skill, Triage of ICSRs, WHO DD Coding

Job Title: Pharmacist Clinical Configuration
Location: Hybrid (1-2 days/week in office), with alternate locations considered. Candidates must reside within 50 miles of Elevance Health PulsePoint locations.


About Us

A member of the Elevance Health family, CarelonRx leverages advanced technologies and a clinical-first approach to provide member-centered, lasting pharmacy care. Elevance Health is dedicated to improving lives and communities while simplifying healthcare.


Position Overview

The Pharmacist Clinical Configuration role involves managing pharmaceutical selection and utilization while supporting core clinical programs such as DUR (Drug Utilization Review), DIS (Drug Information Services), and formulary management.


Key Responsibilities

  • Research and synthesize detailed clinical data related to pharmaceuticals.
  • Develop and configure prior authorization decision trees in workflow tools.
  • Conduct quality assurance of prior authorization decision trees.
  • Provide clinical consulting services to internal stakeholders.
  • Assist in implementing clinical programs within the prior authorization domain.
  • Prepare and deliver information to network physicians.

Minimum Requirements

  • Bachelor’s degree in Pharmacy (BA/BS).
  • Minimum 2 years of managed care pharmacy (PBM) experience or equivalent residency.
  • Active, unrestricted state license to practice as a Registered Pharmacist (RPh).

Preferred Qualifications

  • PharmD degree strongly preferred.
  • Experience in prior authorization processes.
  • Familiarity with policy exposure through P&T committees.
  • Strong skills in oral, written, and interpersonal communication, problem-solving, facilitation, and analysis.

What We Offer

  • Competitive total rewards, including:

    • Paid Time Off (PTO), holidays, and merit increases.
    • Incentive bonus programs.
    • Medical, dental, and vision insurance.
    • 401(k) with matching contributions.
    • Stock purchase plan.
    • Life and disability insurance.
    • Wellness programs and financial education resources.
  • Work-Life Balance: Hybrid work schedule to foster flexibility.

  • Growth Opportunities: A culture of professional development and career advancement.


Elevance Health Culture

At Elevance Health, we are building a supportive culture designed to advance both organizational strategy and personal growth. Our values drive shared success for consumers, associates, and communities alike.


Important Notes

  • Vaccination Requirement: Candidates for certain patient/member-facing roles must be vaccinated against COVID-19 and Influenza unless exempted by federal, state, or local laws.
  • Equal Opportunity: Elevance Health is committed to fostering diversity, equity, and inclusion, ensuring all qualified applicants receive fair consideration for employment.

For application assistance, contact: elevancehealthjobssupport@elevancehealth.com

Join Us: Be part of a dynamic team working to improve healthcare outcomes and make a meaningful impact. Explore this opportunity and apply today!