Pharmacist Clinical (Oncology)

Elevance Health•Cincinnati, OH

9d•$119,360 - $214,848•Hybrid

About The Position

The Pharmacist Clinical (Oncology focused) is responsible for managing the selection and utilization of pharmaceuticals and supports core clinical utilization management programs such as prior authorization, step therapy, quantity limitations and then works with the operational areas to ensure the clinical criteria is implemented correctly. 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.

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.
Must possess an active unrestricted state license to practice pharmacy as a Registered Pharmacist (RPh)

Nice To Haves

PharmD preferred.
Residency and experience with Pharmacy and Therapeutics (P&T) preferred.
Experienced in cross-mapping clinical codes, optimizing drug-utilization screening rules, and validating clinical data accuracy using the Medi-Span database is highly preferred.

Responsibilities

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 Elevance Health or health plan medical directors as needed.
Lead development and maintenance of clinical criteria for drugs that process on the pharmacy and medical benefits (clinical utilization management edits).
Researches and synthesizes high quality clinical evidence related to the efficacy and safety of drugs and biologics.
Reviews clinical evidence and guideline recommendations to create and maintain clinical criteria (clinical utilization management edits) that ensure members receive appropriate, cost effective drug therapy. These point of sale edits include but are not limited to prior authorization, step therapy, and quantity limitation.
Prepares and presents drug clinical criteria through quarterly Pharmacy and Therapeutics (P&T) Process.
Works with the clinical operations teams to ensure appropriate claims system set-up and clinical review algorithms are in place for P&T approved point of sale edits.
Presents and collaboration with internal stakeholders (medical directors, pharmacists, nurses, business area leads, etc.).
Provides drug information support to internal stakeholders as needed.
Serves as a clinical pharmacy resource to pharmacy account management and trend management teams.
Ensures compliance of pharmacy utilization management edits in accordance with state and federal mandates and contractual agreements.
Drug pipeline monitoring and evaluation support.