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Pharmacist Clinical (Mason, Va. Beach, Atlanta, St. Louis) - PS10462 in Mason, OH at Anthem, Inc.

Date Posted: 8/3/2018

Job Snapshot

Job Description

Your Talent. Our Vision. At Anthem, Inc., it’s a powerful combination, and the foundation upon which we’re creating greater access to care for our members, greater value for our customers, and greater health for our communities. Join us and together we will drive the future of health care.
This is an exceptional opportunity to do innovative work that means more to you and those we serve at one of America's leading health benefits companies and a Fortune Top 50 Company.

Pharmacist Clinical (Mason, Va. Beach, Atlanta, St. Louis) - PS10462
The Pharmacist Clinical 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.
  • Prepares and presents therapeutic class reviews, drug monograph and drug evaluation information during quarterly Pharmacy and Therapeutics Committee meetings.
  • 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 Anthem 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 clinical evidence information for network physicians.
  • Serves as a subject matter expert for select therapeutic classes.
  • Provides drug information support to internal stakeholders as needed. 
  • Provide clinical support for various internal clinical programs such as drug utilization review, point of sale edits, and messages communicated to network providers.
  • Develops newsletters related to clinical efficacy, safety, therapeutic impact, and cost for key internal stakeholders.
  • Presents and collaborates with internal stakeholders (medical directors, pharmacists, nurses, business area leads, etc.).
  • Makes clinical determinations on medical and pharmacy prior authorization requests.
  • Performs peer-to-peer conversations with providers’ offices. - Implements new programs as requested by client.
  • Must be a registered pharmacist. 
  • Minimum 2 years of managed care pharmacy (PBM) experience; or any combination of education and experience, which would provide an equivalent background required. 
  • At least 3-5 years’ experience working with pharmacy benefit management operations, or an equivalent background preferred. 
  • Experience working with government programs (Medicare and/or Medicaid) strongly preferred. 
  • Current valid state license to practice pharmacy as RPh required.  
  • PharmD preferred. 
  • Direct clinical program development experience preferred. 
  • Must be available to work business hours 8 am - 9pm EST., holidays, nights and weekends on a rotating schedule.
Anthem, Inc. is ranked as one of America’s Most Admired Companies among health insurers by Fortune magazine and is a 2018 DiversityInc magazine Top 50 Company for Diversity. To learn more about our company and apply, please visit us at An Equal Opportunity Employer/Disability/Veteran.