Clinical Pharmacist - Analytics

Elevance Health•St. Louis, MO

3d•Remote

About The Position

This is a virtual eligible role. You must be within a reasonable distance of a PulsePoint. General business hours, Monday through Friday, local time. Virtual: This role enables associates to work virtually full-time, with the exception of required in-person training sessions, providing maximum flexibility and autonomy. This approach promotes productivity, supports work-life integration, and ensures essential face-to-face onboarding and skill development. Please note that per our policy on hybrid/virtual work, candidates not within a reasonable commuting distance from the posting location(s) will not be considered for employment, unless an accommodation is granted as required by law. Alternate locations may be considered if candidates reside within a commuting distance from an office. This is NOT a dispensing role; it is an analytics role. Responsible for managing the selection and utilization of pharmaceuticals and supports core clinical programs such as DUR, DIS and formulary management. Primary duties may include, but are not limited to: 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. May review and approve or deny 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.

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
Current unrestricted Pharmacist license from the state in which you reside
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 for this position
Strong oral, written and interpersonal communication skills
Problem-solving skills
Facilitation skills
Analytical skills

Nice To Haves

Experience working with Tableau or Power BI
Experience working with tools like SQL, Python and R
PharmD
Experience working with Medicare and STARS data

Responsibilities

Managing the selection and utilization of pharmaceuticals
Supporting core clinical programs such as DUR, DIS and formulary management
Researching and synthesizing detailed clinical data related to pharmaceuticals
Preparing and presenting therapeutic class reviews and drug monograph information to the Pharmacy and Therapeutics Committee
Reviewing and approving or denying coverage for pharmaceuticals based on medical necessity criteria
Coordinating with internal stakeholders or health plan medical directors as needed
Serving as a clinical resource to other pharmacists on areas such as prospective, inpatient and retrospective DURs
Providing dosage conversion and clinical support for therapeutic interventions
Preparing information for network physicians