Pharmacist Clinical - Resident

Elevance Health • San Juan, PR

1d • Hybrid

About The Position

Pharmacist Clinical – Resident Location: This role requires associates to be in-office 3 - 4 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. 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. Be Part of an Extraordinary Team MMM Holdings, LLC is a company that provides Medicare Advantage and Medicaid plans in Puerto Rico. Currently, MMM Holdings, LLC operates in Puerto Rico under Elevance Health, Inc. a leading health company dedicated to improving the quality of life of communities in the United States. Through its affiliated companies, they serve more than 118 million people. The Pharmacist Clinical - Resident will be responsible for various operational or clinical aspects of the Amerigroup pharmacy program, including Prior Authorizations, Medication Therapy Management (MTM), Lock-in, and Drug Utilization Review (DUR) programs.

Requirements

• Requires managed care experience; or any combination of education and experience, which would provide an equivalent background.
• Requires graduation from an accredited school of Pharmacy.
• Will be required to obtain current valid state license to practice as an Registered Pharmacist (RPh) within 90 days of hire.

Nice To Haves

• Knowledge of Managed Pharmacy Environment from an HMO or PBM preferred.
• PharmD preferred.
• 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.

Responsibilities

• Performs daily clinical prior authorizations and coverage determinations for Medicaid and Medicare.
• Completes work related to the Pharmacy and Therapeutics Committee including therapeutic class reviews, policy review, drug monographs, and formulary recommendations.
• Completes a year-long project targeted at improving member care through proper medication management.
• Participates in the pharmaceutical care management process through reviewing member profiles, recommending members for lock-in, case management or disease management.
• Responds to and resolves issues related to member/provider complaints, claims processing issues and appeals.

Benefits

• We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few.

What This Job Offers

• Career Level: Entry Level
• Education Level: No Education Listed
• Number of Employees: 5,001-10,000 employees