Clinical Pharmacist - Data Analytics

Work location - Hybrid 1 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. Alternate locations may be considered if candidates reside within a commuting distance from an office. Please note that per our policy on hybrid/virtual work, candidates not within a reasonable commuting distance from the posting location(s) will not be considered for employment, unless an accommodation is granted as required by law. The Clinical Pharmacist – Data Analytics is responsible for managing the selection and utilization of pharmaceuticals and supports core clinical programs such as DUR, DIS and formulary management. Primary Duties Researches and synthesizes detailed clinical data related to pharmaceuticals. Proactively identify utilization management (UM) strategies that enhance the member experience while delivering positive financial outcomes. Analyze prior authorization (PA) data and trends to develop recommendations, considering rebates, member impact, and operational efficiency. Monitor and evaluate UM performance to ensure effectiveness and alignment with organizational goals. Report on PA performance metrics to support data‑driven decision‑making across teams. Forecast the potential financial and administrative impact associated with UM initiatives. Track the financial impact of recently implemented UM. Build and maintain strong cross‑functional relationships with Trade, Formulary, Clinical, and Actuarial teams to collaboratively develop and implement UM solutions. Support therapeutic class reviews and drug monograph information to the Pharmacy and Therapeutics Committee. May review and approve or deny coverage for pharmaceuticals (as permitted by state/federal law or state/federal program contracts) based on medical necessity criteria, and coordinate with internal stakeholders or health‑plan medical directors as needed. Serve as a clinical resource to other pharmacists on areas such as prospective, inpatient and retrospective DURs and provide dosage conversion and clinical support for therapeutic interventions. Prepare information for network physicians. Position Requirements Requires BA/BS in Pharmacy. Minimum of 2 years of managed care pharmacy (PBM) experience or residency in lieu of work experience; or any combination of education and experience, which would provide an equivalent background. Requires a registered pharmacist. Current unrestricted Pharmacist license in applicable state(s) required. Preferred Qualifications, Skills, and Experiences PharmD preferred. Managed care experience strongly preferred. Previous experience in pharmaceutical data analytics preferred. MBM and/or PBM experience also preferred. 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 U.S. military base, vessel or any embassy located in or outside of the U.S., unless they are command‑sanctioned activities. For URAC accredited areas, associates are expected to have strong oral, written and interpersonal communication skills, problem‑solving skills, facilitation skills, and analytical skills. Compensation & Location Salary range for this position is $119,360 to $205,896. Location(s): Illinois, New Jersey, Cleveland, OH, Columbus, OH. Benefits In addition to your salary, the company offers a comprehensive benefits package, incentive and recognition programs, equity stock purchase, and 401(k) contribution (subject to eligibility requirements). The salary offered is based on several legitimate, non‑discriminatory factors set by the company. Equal Employment Opportunity 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 may contact View email address on click.appcast.io for assistance. Qualified applicants with arrest or conviction records will be considered in accordance with all federal, state, and local laws, including the Los Angeles County Fair Chance Ordinance and the California Fair Chance Act. Prospective employees required to be screened under Florida law should review education and awareness resources at HB531 | Florida Agency for Health Care Administration. #J-18808-Ljbffr Elevance Health