Clinical Pharmacist - Data Analytics

Elevance Health•Cincinnati, OH

1d•$119,360 - $205,896•Hybrid

About The Position

This role requires associates to be in-office 1 - 2 days per week, fostering collaboration and connectivity, while providing flexibility to support productivity and work-life balance. This approach combines structured office engagement with the autonomy of virtual work, promoting a dynamic and adaptable workplace. Alternate locations may be considered if candidates reside within a commuting distance from an office. 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. The Clinical Pharmacist – Data Analytics is 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. Proactively identify utilization management (UM) strategies that enhance the member experience while delivering positive financial outcomes. Analyze prior authorization (PA) data and trends to develop recommendations, considering rebates, member impact, and operational efficiency. Monitor and evaluate UM performance to ensure effectiveness and alignment with organizational goals. Report on PA performance metrics to support data-driven decision-making across teams. Forecast the potential financial and administrative impact associated with UM initiatives. Track the financial impact of recently implemented UM. Build and maintain strong cross-functional relationships with Trade, Formulary, Clinical, and Actuarial teams to collaboratively develop and implement UM solutions Supports 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

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, which would provide an equivalent background.
Requires a registered pharmacist.
Current unrestricted Pharmacist license in applicable state(s) required.

Nice To Haves

PharmD preferred.
Managed care experience is strongly preferred.
Previous experience in pharmaceutical data analytics is preferred.
MBM and/or PBM experience is also 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 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.
Associates in this role are expected to have strong oral, written and interpersonal communication skills, problem-solving skills, facilitation skills, and analytical skills.

Responsibilities

Researches and synthesizes detailed clinical data related to pharmaceuticals.
Proactively identify utilization management (UM) strategies that enhance the member experience while delivering positive financial outcomes.
Analyze prior authorization (PA) data and trends to develop recommendations, considering rebates, member impact, and operational efficiency.
Monitor and evaluate UM performance to ensure effectiveness and alignment with organizational goals.
Report on PA performance metrics to support data-driven decision-making across teams.
Forecast the potential financial and administrative impact associated with UM initiatives.
Track the financial impact of recently implemented UM.
Build and maintain strong cross-functional relationships with Trade, Formulary, Clinical, and Actuarial teams to collaboratively develop and implement UM solutions
Supports 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.