Clinical Pharmacist at Elevance Health

Indianapolis, Indiana, United States

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Not SpecifiedCompensation

Mid-level (3 to 4 years), Senior (5 to 8 years)Experience Level

Full TimeJob Type

UnknownVisa

Healthcare, Pharmacy BenefitsIndustries

Requirements

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
Registered Pharmacist with an active unrestricted state license to practice pharmacy as a Registered Pharmacist (RPh)
For associates working within Puerto Rico who are member 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
Must be located in a state or territory of the United States when conducting utilization review or appeals consideration (unless expressly allowed by state or federal law or regulation), and cannot be located on a US military base, vessel or any embassy
Candidates not within a reasonable commuting distance from posting locations (Indianapolis, IN; Durham, NC; Overland Park, KS) will not be considered unless an accommodation is granted as required by law

Responsibilities

Manages the selection and utilization of pharmaceuticals and supports core clinical programs such as DUR, DIS and formulary management
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 (as permitted by state/federal law or state/federal program contracts) based on medical necessity criteria, and coordinates with internal stakeholders or health plan medical directors as needed
Serves as a clinical resource to other pharmacists on areas such as prospective, inpatient and retrospective DURs and provides dosage conversion and clinical support for therapeutic interventions
Prepares information for network physicians

Skills

Clinical Pharmacy

DUR

Drug Utilization Review

Formulary Management

Therapeutic Class Reviews

Drug Monographs

Pharmacy and Therapeutics Committee

Medical Necessity Criteria

Dosage Conversion

Elevance Health

Integrated health services and digital platform

About Elevance Health

Elevance Health focuses on enhancing the health of individuals throughout their lives by evolving from a traditional health benefits organization into a comprehensive health partner. The company serves over 118 million people, providing support at every stage of health through an integrated approach that addresses a wide range of health needs. Their services are backed by advanced capabilities and a digital health platform that streamlines access to care. Unlike many competitors, Elevance Health emphasizes a holistic view of health, aiming to redefine health and improve community well-being. The ultimate goal is to make health improvements accessible to everyone.

Indianapolis, IndianaHeadquarters

1944Year Founded

$309.4MTotal Funding

IPOCompany Stage

Enterprise Software, Social Impact, HealthcareIndustries

10,001+Employees

Benefits

Medical, dental, & vision insurance

401(k) + match

Paid holidays

Paid Time Off

Incentive bonus programs

Stock purchase plan

Life insurance

Wellness Programs

Financial education resources

Adoption & Surrogacy Assistance

Dependent-care Flexible Spending Account (DCFSA)

Parental Leave

Parental Transition Week

Critical Caregiving Leave

Risks

Departure of CFO John Gallina may create a gap in financial leadership.

Lawsuit against CMS over MA Star Ratings could lead to financial penalties.

CareBridge integration may face operational challenges, disrupting service delivery.

Differentiation

Elevance Health integrates whole health approach with digital health platform for comprehensive care.

Acquisition of CareBridge enhances home health services within Carelon division.

Strategic partnership with Clayton, Dubilier & Rice aims to innovate primary care delivery.

Upsides

AI integration in home health services can reduce hospital readmissions and improve outcomes.

Predictive analytics support early disease detection, aligning with Elevance's whole health approach.

Telehealth expansion offers opportunities to reach more patients remotely.

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