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Description SHIFT: Day JobSCHEDULE: Full-timeYour Talent. Our Vision. At Anthem, Inc., it’s a powerful combination, and the foundation upon which we’re creating greater access to 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. Pharmacist Clinical Sr. - SpecialtyThis position is a Work-from-Home opportunitySummary: Responsible for supporting strategies to strengthen IngenioRx Medical and Pharmacy Specialty programs. Primary duties may include, but are not limited to: Identifying and implementing strategies to manage specialty cost of care on both the medical and pharmacy benefit.
Researching and synthesizing detailed clinical data related to specialty drugs to identify opportunities or impact.
Analyzing specialty pharmacy spend and trends data and creating mitigating strategies in response to trend.
Managing operational utilization management specialty drug program implementations, including regulatory and client requirements.
Ownership of multiple programs currently in varied phases of implementation across all lines of business.
Collaborate with Clinical partners to identify and implement Medical Specialty program enhancement opportunities and cost of care savings while delivering a superior provider experience and focusing on seamless operations.
Other areas of responsibilities include, specialty benefit design strategies, strengthening the specialty value proposition and presenting to internal and external clients as requested.
Qualifications Qualifications:Requires a registered pharmacist; minimum 4 years of managed care pharmacy experience including knowledge of specialty pharmacy - medical, pharmacy and managed care pharmacy practices; or any combination of education and experience, which would provide an equivalent background.
Current unrestricted state license to practice pharmacy as a RPH, required.
PharmD strongly preferred.
Experience in clinical review of coverage determinations - approve or deny coverage for pharmaceuticals under the medical and pharmacy benefit (as permitted by state/federal law or state/federal program contracts) based on medical necessity criteria required.
Managed Care experience required.
More than only retail and specialty pharmacy experience strongly preferred.
Experience within the Pharmacy Benefit Management industry strongly preferred.
Experience with specialty medications covered under the medical benefit strongly preferred
Experience with medical claims and medical data preferred.
Experience with developing and implementing pharmacy quality & cost savings programs.
Strong presentation skills preferred.
Anthem, Inc. is ranked as one of America’s Most Admired Companies among health insurers by Fortune magazine and is a 2018 DiversityInc magazine Top 50 Company for Diversity. To learn more about our company and apply, please visit us at careers.antheminc.com. An Equal Opportunity Employer/Disability/Veteran.REQNUMBER: PS42604
