Prior Authorization Clinical Pharmacist

Elevance Health•Durham, NC

5d•$119,360 - $205,896•Remote

About The Position

The Prior Authorization Clinical Pharmacist evaluates and manages the selection and utilization of pharmaceuticals to support safe, effective, and cost-efficient medication use. The role supports clinical pharmacy programs, including Drug Utilization Review (DUR), Drug Information Services (DIS), and formulary management. The position is described as virtual full-time, except for required in-person training sessions. Candidates generally must live within reasonable commuting distance of the posting location unless an accommodation is granted. For utilization review or appeals consideration, the pharmacist must be located in a U.S. state or territory, subject to stated legal exceptions. The pharmacist researches clinical pharmaceutical data, prepares and presents therapeutic class reviews and drug monographs to the Pharmacy and Therapeutics Committee, and may review coverage requests and approve or deny pharmaceutical coverage based on medical necessity criteria as permitted by law or contract. The role also provides clinical support to pharmacists and health care teams, prepares information for network physicians, and communicates evidence-based medication guidance and recommendations. The listed salary range for Washington is $119,360–$205,896. Actual compensation may vary based on factors including location, experience, education, and skill level. The position is classified as non-management exempt and is listed as first shift.

Requirements

Bachelor of Arts or Bachelor of Science in Pharmacy.
At least 2 years of managed care pharmacy (PBM) experience, or a residency in lieu of work experience, or an equivalent combination of education and experience.
Registered pharmacist.
Current unrestricted pharmacist license in applicable state(s).
For associates working within Puerto Rico in member- or patient-facing roles in a clinical setting or the Best Transportation unit: current Puerto Rico health certificate and current Puerto Rico Law 300 certificate.
For utilization review or appeals consideration, location in a U.S. state or territory is required unless an expressly allowed legal or regulatory exception applies.
Strong oral, written, and interpersonal communication skills, problem-solving skills, facilitation skills, and analytical skills for associates in URAC-accredited areas.

Nice To Haves

Active, unrestricted Registered Pharmacist (RPh) license in North Carolina, Georgia, and/or Washington.
PharmD degree.
PBM experience.
Prior Authorization experience.
Specialty Medication experience.

Responsibilities

Research and synthesize detailed clinical data related to pharmaceuticals.
Prepare and present therapeutic class reviews and drug monograph information to the Pharmacy and Therapeutics Committee.
Review pharmaceutical coverage requests and approve or deny coverage based on medical necessity criteria, as permitted by applicable law or program contracts.
Coordinate with internal stakeholders or health plan medical directors as needed.
Serve as a clinical resource to other pharmacists on prospective, inpatient, and retrospective Drug Utilization Reviews.
Provide dosage conversion and clinical support for therapeutic interventions.
Prepare information for network physicians.
Provide clinical guidance for therapeutic interventions, dosage conversions, and evidence-based medication use.
Develop and communicate drug information and recommendations to network physicians and clinical teams.