Pharmacist Clinical Sr
Company: Anthem, Inc
Location: West Covina
Posted on: May 12, 2022
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Job Description:
Description SHIFT: Day JobSCHEDULE: 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. Summary: This position will
help ensure evidence-based use of drugs and therapies through
formulary management and edit implementation, monitor data for
expected use patterns and trends, and implement corrective action
plans as appropriate. Primary duties may include, but are not
limited to: + Help ensure evidence-based use of drugs and therapies
through formulary management and implementation of clinical edits
(e.g. prior authorization, step edits, and quantity limits) for
drugs that pay on pharmacy and/or medical benefits. + Lower total
cost of care by reducing waste through formulary and edit strategy.
+ Monitor implementation of quarterly formulary and edit changes to
ensure drug usage is as expected for all lines of business
(Commercial, Medicaid, and Medicare). + Monitoring includes: +
Claims data marketshare shifts and trends. + Prior authorization
(PA) requests, approvals, and denials. + Evaluate PA review
decisions made by the utilization management team. + Formulary
additions and deletions. + Claim reject volume (formulary, prior
authorization, step therapy) + Where there is an issue, investigate
root cause. + Establish and implement a corrective action plan to
address any underlying issues identified. + Work collaboratively
with others outside the immediate department to lead monitoring of
formulary and edit performance. + Lead and facilitate solutions as
needed to ensure successful formulary and edit implementation.
Qualifications General Qualifications: + Requires a registered
pharmacist; minimum 2 years of managed care pharmacy experience
including knowledge of current health care and managed care
pharmacy practices; or any combination of education and heath plan
or PBM experience, which would provide an equivalent background. +
Current state unrestricted license to practice pharmacy as a RPH
required. Preferred Qualifications: + Excellent clinical skills,
analytical ability, strategic planning, organizational, and
leadership skills preferred. + Proficiency in Excel, PowerPoint
preferred. + Strong verbal and written communication skills is
preferred. + Ability to lead projects and work collaboratively with
large groups is 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 ability@icareerhelp.com for assistance. REQNUMBER:
PS71846-California
Keywords: Anthem, Inc, West Covina , Pharmacist Clinical Sr, Healthcare , West Covina, California
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