Anthem, Inc. Pharmacist Clinical Senior in Pembroke Pines, Florida
SHIFT: Day Job
Your 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 care companies and a Fortune Top 50 Company.
Pharmacist Clinical Senior
*This is a work at home position
Summary: Responsible for auditing utilization management cases.
Primary duties may include, but are not limited to: • Researches and synthesizes detailed clinical data related to utilization management and appeal cases primarily for Medicaid business. • Serves as a clinical resource on utilization management to other departments • May serve as clinical support on regulatory or accreditation audits • 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 coordinates with Anthem or health plan medical directors as needed
Qualifications: • Requires a Bachelor’s degree in Pharmacy, minimum 4 years of experience as a pharmacist in a clinical setting; or any combination of education and experience, which would provide an equivalent background. • Requires a registered pharmacist; must possess an active unrestricted state license to practice pharmacy as a Registered Pharmacist (RPh). • PharmD 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 US military base, vessel or any embassy located in or outside of the U.S., unless they are command-sanctioned activities. • For URAC accredited areas the following applies: Requires strong oral, written and interpersonal communication skills, problem-solving skills, facilitation skills, and analytical skills.
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.
Anthem, Inc. is ranked as one of America’s Most Admired Companies among health insurers by Fortune magazine and has been named a 2019 Best Employers for Diversity by Forbes. To learn more about our company and apply, please visit us at careers.antheminc.com. An Equal Opportunity Employer/Disability/Veteran. Anthem promotes the delivery of services in a culturally competent manner and considers cultural competency when evaluating applicants for all Anthem positions.