Description
SHIFT: Day Job
SCHEDULE: Full-time
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 - Clinical Reviews/Injectables (PS39727)
*Locations: Mason, OH; Las Vegas, NV; Va. Beach, VA; St. Louis, MO; Minnetonka, MN, Savannah and Tampa Bay locations preferred
*Indiana or California unrestricted pharmacist license strongly preferred
Summary: Responsible for the clinical review and medical necessity determination for medical injectable prior authorizations requested for the outpatient setting.
Primary duties may include, but are not limited to:
• Research and apply clinical expertise relative to drug policies and clinical records during medical injectable prior authorization reviews
• Support the clinical review of medical injectable drugs through approvals and denials of services requested (as permitted by state/federal law or state/federal program contracts) based on medical necessity criteria, and coordinate with Ingenio Rx or Anthem medical directors as needed.
• Implementation and execution of outpatient specialty medical injectable clinical programs such as Step Therapy, Dose and Site of Care.
• Partner with other pharmacists to support departmental education and training
Qualifications
Qualifications:
• Must possess an active unrestricted state license to practice pharmacy as a Registered Pharmacist (RPh).
• An active unrestricted Indiana or California state license is strongly preferred.
• Minimum 2 years of managed care pharmacy, pharmacy benefit management (PBM) experience; or any combination of education and experience, which would provide an equivalent background required.
• 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.
• Medical Injectable specialty drug knowledge preferred.
• PharmD preferred.
• Direct clinical program development experience preferred.
• 1st and 2nd shift schedules along with weekend rotations are required.
• Bilingual in Spanish/English strongly preferred (a language assessment may be required).
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 careers.antheminc.com. An Equal Opportunity Employer/Disability/Veteran.