Description
Description
SHIFT: Day Job
SCHEDULE: Full-time
Be part of an extraordinary team 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?
A proud member of the Anthem, Inc. family of companies, IngenioRx leverages the power of new technologies and a strong, clinical-first lens, to deliver member-centered, lasting pharmacy care.
Pharmacist Clinical - Clinical Reviews/Injectables
Fulltime Monday through Friday, with holiday and weekend rotation. Preferred 2nd shift, starting time 11am - 7pm or 12pm - 8pm in the time zone of applicant's location.
The Pharmacist Clinical is responsible for completing clinical reviews in an accurate, efficient, and timely manner while applying our core clinical programs such as medical necessity, does and step therapy. Primary duties may include, but are not limited to:
+ Review and approve or deny prior authorizations 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.
+ Conducting peer to peer encounters with prescribers based on departmental policy and procedures
+ Participation in departmental meetings and cross training opportunities
+ Serve as a clinical resource to other clinical reviewers and support resources across the department
+ Qualifications - External
Qualifications
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.
Preferred Qualifications:
+ Indiana Licensed Pharmacist or California Licensed Pharmacist and CA Resident highly preferred.
+ Associates in this role are expected to have strong oral, written and interpersonal communication skills, problem-solving skills, facilitation skills, and analytical skills.
+ At least 3 years' experience working with (PBM) pharmacy benefit management operations, or an equivalent background preferred.
+ Experience working with government programs (Medicare and/or Medicaid) strongly preferred.
+ Experience in prior authorizations preferred.
+ Oncology prior authorization review experience preferred
+ Medical Injectable specialty drug knowledge preferred.
+ Direct clinical program development experience preferred.
+ RPh willing to work PST or residing in a PST State preferred
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 Anthem. 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 Anthem approves - a valid religious or medical explanation as to why you are not able to get vaccinated that Anthem is able to reasonably accommodate. Anthem will also follow all relevant federal, state and local laws. Anthem, Inc. 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.antheminc.com. Anthem 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 for assistance.
REQNUMBER: PS71516-Ohio
