Anthem Pharmacist Consultant - Nationwide (Telecommute ) - 128538 in Andover, Massachusetts

Pharmacist Consultant – telecommute

/ Your Talent. Our Vision. / At Anthem, Inc., it’s a powerful combination, and the foundation upon which we’re creating greater 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.

Responsible for supporting disease management programs and physicians care plans through drug therapy evaluation and consultation for program participants.

Primary duties may include, but are not limited to: * Experience in Injectable/Specialty Drug oversight including Drug Utilization Management. * Make prior authorization determinations based upon formulary and evidence-based clinical data. * Prior authorization determinations, research, and synthesize detailed clinical data related to injectable pharmaceuticals. * This position will coordinate with the Medical Directors and RNs in the UM Department, Providers.
* Provides evaluation of member Rx needs and therapies through review of medication history to determine if medications are appropriate. * Provide injectable drug medical necessity reviews covered under the Medical benefit (Part B). * Determines potential barriers to compliance and identifies solutions to overcome barriers. * Adhere to all Medicare and policy and procedures
* Ensures that providers understand appropriate use of current prescriptions. * Reviews medication requests with physicians and/or physician representatives when therapies do not meet national standards. * Serves as a resource to the clinical team in disease management and other clinical areas.

  • Requires an RPh; 2 years of clinical experience; or any combination of education and experience, which would provide an equivalent background.
  • Current unrestricted RPh license is required.
  • PharmD degree preferred.
  • Experience with direct patient counseling, provider interaction and/or education preferred.
  • Understanding of the Specialty Drug market preferred.
  • Clinical knowledge of Biotech/Oncology drugs preferred.
  • Part B experience highly recommended.
  • Must have excellent PC skills (Word, Outlook, Excel).
  • Managed care experience is preferred.
  • Hours of operation are Monday through Friday 8:00am to 8:00pm EST
  • May need to work weekends and holidays on an infrequent rotating basis. / Anthem, Inc. is ranked as one of America’s Most Admired Companies among health insurers by Fortune magazine and is a 2015 DiversityInc magazine Top 50 Company for Diversity. To learn more about our company and apply, please visit us at EOE. M/F/Disability/Veteran. /

Job Medical

Title: Pharmacist Consultant - Nationwide (Telecommute ) - 128538

Location: MA-Andover

Requisition ID: 128538