19 Sep
Pharmacist Clinical/Sr - Medical Pharmacy UM
California, Placentia 00000 Placentia USA

Vacancy expired!

Description SHIFT: Day JobSCHEDULE: Full-timeYour 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/Pharmacist Clinical Sr. - Medical Pharmacy UMThis position is a Work-from-Home opportunitySummary: Responsibilities involve implementation and management of medical drug utilization management strategies to support pharmacy quality and cost strategies.Primary duties may include, but are not limited to:

Develops and executes strategies and programs to improve medical drug utilization management (UM).

Develops and maintains the medical drug pre-certification medical necessity based program.

Participates in Pharmacy and Therapeutics (P&T) and Medical Policy & Technology Assessment Committee (MPTAC) meetings. Point of contact for P&T and MPTAC collaborations.

Maintains the source of truth documents for the medical specialty drug programs, including pre-cert, step therapy, dosing, and site of care.

Identifies material adverse changes (MACs) of new products and implements downstream, including provider notifications and operational implementations.

Responsible for submission to systems which build UM rule edits into claims systems.

UM dose program lead for all lines of business.

Provides ongoing support for multiple UM programs, including product selection, clinical vetting, issue resolution, enhancement ideation, vetting, and implementation, and performance tracking.

Responsible for developing and implementing medical pharmacy programs. Ownership of multiple programs currently in varied phases of implementation.

Serves as a clinical resource to other pharmacists, physicians and non-clinical staff.

Performs drug utilization analyses.

Qualifications Qualifications:This position will be hired as a Pharmacist Clinical or Pharmacist Clinical Sr. depending upon the background and experience of the chosen candidate.Pharmacist Clinical

Requires a registered pharmacist; minimum 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.

PharmD preferred.

Must possess an active, unrestricted license to practice as an RPh required.

Managed care experience required.

Experience with developing and implementing pharmacy quality & cost measures.

Experience with medical drug utilization management preferred.

More than only retail pharmacy experience strongly preferred.

Pharmacist Clinical Sr.

Requires a registered pharmacist; minimum 4 years of experience as a Clinical Pharmacist in Managed Care; or any combination of education and experience, which would provide an equivalent background.

Must possess an active, unrestricted license to practice as an RPh required.

PharmD preferred.

Managed Care experience required.

Must have prior experience with strategy and program development including execution of developed programs.

Experience with developing and implementing pharmacy quality & cost measures.

Experience with medical drug utilization management strongly preferred.

Current knowledge of electronic medical records, e-prescribing and electronic gap in care messages.

More than only retail pharmacy experience strongly preferred.

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.REQNUMBER: PS39370

Vacancy expired!


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