Pharmacist Clinical Sr

Company: Anthem, Inc
Location: West Covina
Posted on: May 12, 2022

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