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 California (CA) specific formularies.
Collaborate with internal teams on submission of CA specific utilization management coding as well as enterprise commercial coding as needed.
Coordinate policy and utilization management (UM) updates with the formulary team.
Partner with CA compliance and CA account management teams on mandates and other regulations impacting UM criteria.
Prepare, submit, and track enterprise clinical criteria resulting from Pharmacy & Therapeutics meetings.
Collaborate as needed on clinical criteria development for custom clients.
Collaborate with internal review teams to ensure client intent, client policies, and Carelon policies are captured and operating as expected.
Collaborate with client and internal partners to address client oversight/audit findings
Support Pharmacy & Therapeutics meetings 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, 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.
Utilization Management experience highly desired.
Claims Coding experience preferred.
For candidates working in person or remotely in the below location(s), the salary* range for this specific position is $117,600 to $201,600
Locations: California; Colorado; District of Columbia (Washington, DC), Maryland, Nevada; New York; Washington State
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.
