Job Detail

Clinical Pharmacist - Anthem, Inc.
Buffalo, New York
Posted: Oct 26, 2021 06:09

Job 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 care companies and a Fortune Top 50 Company.

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:

  • Lead development and maintenance of drug clinical criteria (clinical utilization management edits)

  • Prepares and presents drug clinical criteria through quarterly Pharmacy and Therapeutics (P&T) Process

  • Researches and synthesizes high quality clinical evidence related to the efficacy and safety of drugs and biologics

  • Reviews clinical evidence and guideline recommendations to create and maintain clinical criteria (clinical utilization management edits) that ensure members receive appropriate, cost effective drug therapy. These point of sale edits include but are not limited to prior authorization, step therapy, and quantity limitation

  • Works with the clinical operations teams to ensure appropriate claims system set-up and clinical review algorithms are in place for P&T approved point of sale edits

  • Presents and collaborates with internal stakeholders (medical directors, pharmacists, nurses, business area leads, etc.)

  • Provides drug information support to internal stakeholders as needed

  • Serves as a clinical pharmacy resource to pharmacy account management and trend management teams - Ensures compliance of pharmacy utilization management edits in accordance with state and federal mandates and contractual agreements.

  • Drug pipeline monitoring and evaluation support


Minimum Qualifications

  • Requires 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).

  • 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.

    Preferred Qualifications

  • Strong oral, written and interpersonal communication skills, problem-solving skills, facilitation skills, and analytical skills.

  • PharmD 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.

    Anthem, Inc. has been named as a Fortune 100 Best Companies to Work ForR, is ranked as one of the 2020 World's Most Admired Companies among health insurers by Fortune magazine, and a 2020 America's Best Employers for Diversity by Forbes. To learn more about our company and apply, please visit us at An Equal Opportunity Employer/Disability/Veteran. Anthem promotes the delivery of services in a culturally competent manner and considers cultural competency when evaluating applicants for all Anthem positions.

    REQNUMBER: PS61120-New%20York

Job Detail

Company Overview

Anthem, Inc.

Buffalo, New York