Job description
Your Future Evolves Here
Evolent Health has a bold mission to change the health of the nation by changing the way health care is delivered. Evolenteers make a difference wherever they are, whether it is at a medical center, in the office, or while working from home across 48 states. We empower you to work from where you work best, which makes juggling careers, families, and social lives so much easier. Through our recognition programs, we also highlight employees who live our values, give back to our communities each year, and are champions for bringing their whole selves to work each day. If you’re looking for a place where your work can be personally and professionally rewarding, don’t just join a company with a mission. Join a mission with a company behind it.
Why We’re Worth the Application:
- We continue to grow year over year.
- Recognized as a leader in driving important
diversity, equity, and inclusion (DE&I) efforts.
- Achieved a 100% score two years in a row on the
Human Rights Campaign's Corporate Equality Indexrecognizing us as a best place to work for LGBTQ+ equality.
- Named to Parity.org’s list of the best companies for women to advance for
3 years in a row(2020, 2021 and 2022).
- Continue to prioritize the employee experience and achieved a 90% overall engagement score on our employee survey in May 2022.
- Publish an annual
DE&I reportto share our progress on how we’re building an equitable workplace.
What You’ll Be Doing:
The Role
Evolent Health is looking for a licensed Clinical Pharmacist – Operations to be a key member of the Pharmacy Services team. This individual will play a critical role in executing Evolent Health’s mission by serving as a Utilization Management Pharmacist. The Pharmacy team has a blend of responsibilities pertaining to health plan management of drugs managed through both the medical and pharmacy benefits across all lines of business (Commercial, Exchange, Medicare, and Medicaid). We are looking for team members that possess high energy, a strong work ethic, integrity, who are kind and empathetic, have a sense of humor, and who enjoy working for a collaborative, team-oriented system.
Responsibilities
Utilization Management
- Conduct utilization reviews (e.g., prior authorization, quantity limit, step therapy) for drug coverage under both the pharmacy and medical benefits for all lines of business
- Evaluate requests for clinical appropriateness and cost effectiveness
- Coordinate with pharmacy technicians, Pharmacists, and Medical Directors on UM activities
- Ensure cases are reviewed in accordance with State and/or Federal guidelines including turnaround time requirements
- Discuss clinical strategy and decision rationale with prescribers
- Participate in UM quality review and inter-rater reliability processes
Clinical Operations Support
- Supports P&T process including the development of therapeutic class/drug monographs
- Research and develop therapy-specific clinical policies and utilization management programs such as Prior Authorization, Step Therapy, Quantity Limit, and/or Coverage Determination programs
- Support utilization management team projects as needed
- Willingness to assist within other areas of pharmacy and support all lines of business, when necessary
Required Qualifications
- Pharmacy degree; either BS Pharmacy or PharmD
- Current active Pharmacist license in good standing in state of residence. Willingness to achieve and maintain licensure in multiple states, if necessary.
- Willingness to work up to every other weekend
- Willingness to work evenings (until 8 pm EST) and holidays, as needed
Preferred Qualifications
- A minimum of 1 year experience at a health plan or PBM
- Experience reviewing and developing drug management criteria (pharmacy and/or medical JCode)
- Excellent written and verbal communication skills
- Ability to navigate ambiguity with structured problem-solving and decision-making
Skills and Behavioral Attributes
- Ability to make independent clinical decisions
- Committed to team-oriented work environment
- Exceptional interpersonal, presentation, oral and written communication skills
- Strong work ethic built on a foundation of proactivity
- Committed to the practice of inquiry and listening
- Navigate ambiguity with structured problem-solving and decision-making
- Analytic with the ability to transform data & trends into actionable insight
Technical Requirements:
We require that all employees have the following technical capability at their home: High speed internet over 10 Mbps and, specifically for all call center employees, the ability to plug in directly to the home internet router. These at-home technical requirements are subject to change with any scheduled re-opening of our office locations.
Evolent Health is an equal opportunity employer and considers all qualified applicants equally without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, veteran status, or disability status.
Compensation Range: The minimum salary for this position is $110000, plus benefits. Salaries are determined by the skill set required for the position and commensurate with experience and may vary above and below the stated amounts.
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