Pharmacist Clinical Senior

Pharmacist Clinical Senior

CarelonRx is a proud member of the Elevance Health family of companies providing unparalleled level of service in pharmacy benefits. By leveraging the power of new technologies, our strong, clinical-first lens and deep pharmacy expertise, we are actively defining our innovative role in the industry.

Build the possibilities. Make an extraordinary impact.

Title : Pharmacist Clinical Sr.

Location(s) : Miami, FL, Tampa, FL, Altamonte Springs, FL

Hybrid : This role requires associates to be in-office 1 - 2 days per week, fostering collaboration and connectivity, while providing flexibility to support productivity and work-life balance. This approach combines structured office engagement with the autonomy of virtual work, promoting a dynamic and adaptable workplace.

The FL Health Plan is looking for a dedicated pharmacist to support the SMI / HIV population. The Pharmacist Clinical Sr. will be responsible for developing and implementing pharmacy programs for the Florida Health Plan. The Pharmacist Clinical Senior will be the primary contact for the FL Medicaid Health Plan's SMI (Serious Medical Issues) and HIV pharmacy program managing stakeholder communications as well as ensuring the proper reaction to and resolution of issues concerning the pharmacy benefit program. This position will act as a support resource for the sales team regarding efforts to improve the performance of the pharmacy benefit for existing accounts.

How you will make an impact :

• Provides clinical consulting services to client and implements clinical information and education programs.
• Assists in developing formularies.
• Performs drug utilization analyses.
• Participates in and presents to Pharmacy and Therapeutics (P&T) committee meetings and management of client formulary.
• Identify and address medication adherence, polypharmacy, medication contraindications, medications indicated that are not prescribed (e.g., statins) or other concerns in collaboration with pharmacies, providers, and CM department.
• Administer HEDIS Measures and State Dashboard Measures related to pharmacy.
• Oversee Pharmacy Restriction Program.
• Support to our HIV experienced PCPs who increasingly treat an aging population with behavioral and co-morbid conditions resulting in complex pharmaceutical portraits.
• Serve as in-house SME and resource for providers that may be prescribing HIV treatment regimens that are outside of the recommended guidelines.
• Collaborate with Quality, Case Management, Provider Relations, Finance, and other departments with a shared goal of improving outcomes and reducing costs.

Minimum Requirements :

Preferred Skills, Capabilities, and Experiences :

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.

For URAC accredited areas, the following professional competencies apply : Associates in this role are expected to have strong oral, written and interpersonal communication skills, problem-solving skills, facilitation skills, and analytical skills. For associates working within Puerto Rico who are member or patient facing either in a clinical setting or in the Best Transportation unit, a current PR health certificate and a current PR Law 300 certificate are required for this position.

Job Level : Non-Management Exempt

Workshift : Not specified

Job Family : MED >

Licensed / Registered Pharmacist / Pharmacy Technician

Elevance Health is a health company dedicated to improving lives and communities and making healthcare simpler. We are a Fortune 25 company with a longstanding history in the healthcare industry, looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve.

At Elevance Health, we are creating a culture that is designed to advance our strategy but will also lead to personal and professional growth for our associates. Our values and behaviors are the root of our culture. They are how we achieve our strategy, power our business outcomes and drive our shared success - for our consumers, our associates, our communities and our business.

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.

Elevance Health operates in a Hybrid Workforce Strategy. Unless specified as primarily virtual by the hiring manager, associates are required to work at an Elevance Health location at least once per week, and potentially several times per week. Specific requirements and expectations for time onsite will be discussed as part of the hiring process.

The health of our associates and communities is a top priority for Elevance Health. We require all new candidates in certain patient / member-facing roles to become vaccinated against COVID-19 and Influenza. If you are not vaccinated, your offer will be rescinded unless you provide an acceptable explanation. Elevance Health will also follow all relevant federal, state and local laws.

Elevance Health 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 elevancehealthjobssupport@elevancehealth.com for assistance. Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state, and local laws, including, but not limited to, the Los Angeles County Fair Chance Ordinance and the California Fair Chance Act.