at Elevance Health in CHICAGO, Illinois, United States
Job Description
Clinical Pharmacist – CarelonRx ?
Location: The ideal candidate will live within 50 miles of one of our pulse point locations and will work on a hybrid work model (1-2 days per week in the office).
A proud member of the Elevance Health family of companies, CarelonRx (formerly IngenioRx) leverages the power of new technologies and a strong, clinical-first lens, to deliver member-centered, lasting pharmacy care.
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:
+ Maintain clinical criteria for prior authorization reviews for custom and standard criteria sets
+ Collaborate with internal review teams to ensure client intent, client policies, and Carelon policies are captured and operating as expected
+ Conduct outreach to quality assurance teams within Carelon as topics arise from the client
+ Address prior authorization inquiries from clients by conducting initial research, outreach to internal teams for detailed reviews/assessments, and providing resolution feedback to the client
+ Support Pharmacy & Therapeutics meetings
+ Prepare, submit, and track clinical criteria resulting from Pharmacy & Therapeutics meetings
+ Coordinate policy and utilization management updates with formulary
+ Collaborate with client and internal partners to address client oversight/audit findings
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, that would provide an equivalent background. Requires a registered pharmacist.
+ Must possess an active unrestricted state license to practice pharmacy as a Registered Pharmacist (RPh).
Preferred Qualifications, Skills, and Experiences:
+ PharmD preferred.
Unless expressly allowed by state or federal law, or regulation, must be located in a state or territory of the United States when conducting a 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. For associates working within Puerto Rico who are members or patient-facing either in a clinical setting or in the Best Transportation unit, a current PR health certificate, and a current PR Law 300 certificate are required for this position.
For candidates working in person or remotely in the below locations, the salary* range for this specific position is $112,000 to $201,600.
Locations: California; Colorado; Hawaii; Nevada; New York; Washington State; Jersey City, NJ
In addition to your salary, Elevance Health offers benefits such as a comprehensive benefits package, incentive and recognition programs, equity stock purchase, and 401k contribution (all benefits are subject to eligibility requirements). The salary offered for this specific position is based on a number of legitimate, non-discriminatory factors set by the company. The company is fully committed to ensuring equal pay opportunities for equal work regardless of gender, race, or any other category protected by federal, state, and local pay equity laws.
- The salary range is the range Elevance Health in good faith believes is the range of possible compensation for this role at the time of this posting. This range may be modified in the future and actual compensation may vary from posting based on geographic location, work experience, education, and/or skill level. Even within the range, the actual compensation will vary depending on the above factors as well as market/business considerations. No amount is considered to be wages or compensation until such amount is earned, vested, and determinable under the terms and conditions of the applicable policies and plans. The amount and availability of any bonus, commission, benefits, or any other form of compensation and benefits that are allocable to a particular employee remains in the Company’s sole discretion unless and until paid and may be modified at the Company’s sole discretion, consistent with the law.
