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Pharmacist Clinical - Population Health Management Pharmacist

Location:

  • Indiana, Indiana
  • Kentucky, Kentucky
  • Tennessee, Tennessee
  • Illinois, Illinois
  • Ohio, Ohio

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Description

Job Description Summary 

Responsible for managing the selection and utilization of pharmaceuticals and supports core clinical programs for contracted provider groups, formulary management, achieving quality and cost goals.

Primary duties may include, but are not limited to:  

  • Researches and synthesizes detailed clinical data related to pharmaceuticals to assist contracted providers to achieving cost and quality goals.  
  • Serves as a clinical resource to external pharmacists and contracted providers on areas such as prospective, inpatient, and retrospective DURs and clinical support for therapeutic interventions.  
  • Prepares information for network physicians using data within provider tools including excel.  
  • During practice-level discussions, act as a subject matter expert in pharmacy-related clinical measures for value-based care agreements 

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.  
  • Requires a registered pharmacist.  
  • Must possess an active unrestricted state license to practice pharmacy as a Registered Pharmacist (RPh). PharmD 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. For URAC accredited areas, the following professional competencies apply: Associates in this role are expected to have strong oral, written and interpersonal communication skills, problem-solving skills, facilitation skills, and analytical skills. 

Preferences: 

The Pharmacist Clinical is responsible for providing clinical pharmacy support to Medicare and Commercial providers. Duties and responsibilities will be focused on improving quality (STAR and HEDIS) and cost measures through close collaboration with providers engaged in value-based care arrangements.  You will be responsible for influencing providers to change prescribing practices to improve member health and reduce the total cost of care.

To be successful in this role, you’ll need to have excel experience and passionate about building relationships with external provider partners to improve member health. We are looking for candidates with PBM or Managed Care experience; retail pharmacy experience does not apply. 

Primary duties may include, but are not limited to: 

  • Support network physicians by analyzing organizational and practice-level reports and identifying opportunities to: 
  • Improve pharmacy quality (STAR, HEDIS, etc) 
  • Reduce pharmacy cost 
  • During practice-level discussions, act as a subject matter expert in pharmacy-related clinical measures for value-based care agreements 
  • Attend external provider meetings to communicate practice-level pharmacy goals and opportunities for reaching goals  
  • Educate internal matrix provider partners about pharmacy programs and goals 
  • Field questions from providers related to Pharmacy programs (benefits, reporting tools, CMS, formulary, etc.) 
  • Participate in development and testing of pharmacy provider tools with the lens of a clinical user 
  • Stay up to date with STAR & HEDIS measures 

Provide education to the external network providers as requested/needed in support of Clinical pharmacy measures 
 


Please be advised that Elevance Health only accepts resumes from agencies that have a signed agreement with Elevance Health. Accordingly, Elevance Health is not obligated to pay referral fees to any agency that is not a party to an agreement with Elevance Health. Thus, any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of Elevance Health.

Be part of an Extraordinary Team

Elevance Health is a health company dedicated to improving lives and communities – and making healthcare simpler. Previously known as Anthem, Inc., we have evolved into a company focused on whole health and updated our name to better reflect the direction the company is heading.

We are looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve. You will thrive in a complex and collaborative environment where you take action and ownership to solve problems and lead change. Do you want to be part of a larger purpose and an evolving, high-performance culture that empowers you to make an impact?

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.

The health of our associates and communities is a top priority for Elevance Health. We require all new candidates to become vaccinated against COVID-19. If you are not vaccinated, your offer will be rescinded unless you provide – and Elevance Health approves – a valid religious or medical explanation as to why you are not able to get vaccinated that Elevance Health is able to reasonably accommodate. Elevance Health will also follow all relevant federal, state and local laws.

Elevance Health has been named as a Fortune Great Place To Work in 2021, is ranked as one of the 2021 World’s Most Admired Companies among health insurers by Fortune magazine, and a Top 20 Fortune 500 Companies on Diversity and Inclusion. To learn more about our company and apply, please visit us at careers.ElevanceHealthinc.com. Elevance Health is an Equal Employment Opportunity employer and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws. Applicants who require accommodation to participate in the job application process may contact ability@icareerhelp.com for assistance.

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