Prior Authorization Clinical Pharmacist

Elevance Health

. Evaluate and manage pharmaceutical selection and utilization for safe, effective, and cost-efficient medication use .

Posted 10/23/2026full-timeRemote • United StatesJuniorMid-Level💰 $119,360 - $205,896 per yearWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates expertise in managed care pharmacy, including drug utilization review, formulary management, and clinical support for therapeutic interventions. Proficient in synthesizing clinical pharmaceutical data and communicating recommendations to healthcare professionals.

Highest-signal resume keywords

Managed Care Pharmacy ExperienceRegistered PharmacistDrug Utilization ReviewPharmacy Benefit Management (PBM)Clinical Guidance for Therapeutic Interventions

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Pharmaceutical SelectionClinical Data SynthesisDosage ConversionTherapeutic Class ReviewsDrug Monographs PreparationPrior AuthorizationSpecialty Medication ManagementEvidence-Based Medication UseFormulary ManagementMedication Coverage Review

Soft Skills

Strong Oral CommunicationWritten CommunicationInterpersonal CommunicationProblem-SolvingFacilitationAnalytical Skills

Certifications & Qualifications

Pharmacist LicenseCurrent PR Health CertificateCurrent PR Law 300 Certificate

Industry Keywords

Pharmacy Benefit Management (PBM)Drug Information ServicesPharmacy and Therapeutics CommitteeClinical ResourceHealth Plan Medical Directors

About the role

Key responsibilities & impact

Evaluate and manage pharmaceutical selection and utilization for safe, effective, and cost-efficient medication use
Support Drug Utilization Review, Drug Information Services, and formulary management programs
Research and synthesize detailed clinical pharmaceutical data
Prepare and present therapeutic class reviews and drug monographs to the Pharmacy and Therapeutics Committee
Review and approve or deny pharmaceutical coverage based on medical necessity criteria, where permitted
Coordinate with internal stakeholders and health plan medical directors
Serve as a clinical resource to pharmacists on prospective, inpatient, and retrospective DURs
Provide dosage conversion and clinical support for therapeutic interventions
Prepare information for network physicians
Provide clinical guidance for therapeutic interventions, dosage conversions, and evidence-based medication use
Develop and communicate drug information and recommendations to network physicians and clinical teams

Requirements

What you’ll need

BA/BS in Pharmacy
Minimum of 2 years of managed care pharmacy (PBM) experience or residency in lieu of work experience
Registered pharmacist
Current unrestricted Pharmacist license in applicable state(s)
For associates working within Puerto Rico who are member or patient facing in a clinical setting or Best Transportation unit: current PR health certificate and current PR Law 300 certificate
Active, unrestricted RPh license in North Carolina and/or Washington highly preferred
PharmD preferred
PBM experience preferred
Prior Authorization experience preferred
Specialty Medication experience preferred
Must be located in a state or territory of the United States when conducting utilization review or appeals consideration, unless expressly allowed by law or regulation
Cannot be located on a US military base, vessel, or embassy unless conducting command-sanctioned activities
Strong oral, written, and interpersonal communication skills
Problem-solving skills
Facilitation skills
Analytical skills

Benefits

Comp & perks

Associate Referral Bonus: $250
Comprehensive benefits package
Merit increases
Paid holidays
Paid Time Off
Incentive bonus programs
Medical benefits
Dental benefits
Vision benefits
Short- and long-term disability benefits
401(k) + match
Stock purchase plan
Life insurance
Wellness programs
Financial education resources
Virtual full-time work arrangement, except required in-person training sessions
Equity