Pharmacist Clinical or Clinical Pharmacy Analyst,

/Your Talent. Our Vision./ At Anthem Blue Cross , a proud member of the Anthem, Inc. family of companies, it?s a powerful combination, and the foundation upon which we?re creating greater 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.
The Clinical Pharmacy Services and Policy Department is responsible for overseeing the Pharmacy and Therapeutics (P&T) Process (Clinical Review Committee and Value Assessment Committee) from end to end for all formularies for Commercial (National, Preferred, Essential, and Select), Medicaid, and Medicare. The department is also responsible for developing and maintaining all clinical pharmacy policies and drug utilization management criteria that result in point of sale clinical edits. Additional department responsibilities include ensuring ensure high profile pipeline drugs are managed appropriately at the time of drug launch, formulary strategy, formulary management, and formulary maintenance maintenance of all formularies, measuring the financial impact of formulary decisions, ensuring P&T compliance with state and federal regulatory requirements for all LOBs, oversee clinical research and outcomes analysis to support P&T decisions, and development of programs designed to promote use of effective drug therapies while keeping health care affordable. The department is accountable for formulary related member and provider communications. The overall goal of Anthem?s formularies is to improve health of Anthem?s members while keeping healthcare affordable for Anthem members and Americans.
The Clinical Pharmacist/Clinical Pharmacy Analyst requires a clinical pharmacy and data analytic background to leverage integrated pharmacy and medical data help identify members who meet prior authorization criteria for select drugs (e.g. criteria based on age, diagnosis, prior use select drugs, etc.) so that the prior authorization can be granted for the member without impacting the member and provider experience at the pharmacy (AKA Smart Edits). By proactively implementing Smart Edits, we are able to ensure clinically appropriate use of drugs without the member and provider needing to submit a request for a prior authorization.
Primary Responsibilities
Identify high volume prior authorizations that are clinically appropriate for a ?Smart Edit? program, resulting in the maximizing the reduction in prior authorization requests.
Collaborate with the clinical drug utilization management pharmacists to develop clinical criteria appropriate for Smart Edits.
Develop and maintain an analytic process from end-to-end for management of Smart Edits leveraging our existing pharmacy and medical data (e.g. EDWARD).
Collaborate with Express Scripts (ESI), our pharmacy benefit management vendor to implement the Smart Edits.
Ensure quality and accurate implementation of the edits
Continuous refinement of the Smart Edit process resulting in maximum reduction of the volume of prior authorizations, improving the experience of our members and providers.
Collaborate with data analysts on management and maintenance of the program.
Clinical analytic Support for formulary decision-making.
Licensed pharmacist.
Minimum of 2 years of health plan or PBM experience, or equivalent.
Minimum of 2 years of experience in using pharmacy and medical claims data.
Basic understanding or experience with clinical drug utilization management edits.
Proficiency in SAS or similar data analytic software.
Proficiency in the use of MS Office software.
Ability to work professionally and collaboratively in a team-oriented environment.
Strong verbal and communication skills with the ability to articulate technical detail in simple and clear manner.
Ability to produce excellent data and analytic work output in a timely manner.
Actively pursues continuous quality/process improvement in self and work tasks.
Ability to innovate and solve problems and tasks with initiative.
PharmD degree.
Masters of Science degree in outcomes research, pharmacoeconomics, epidemiology, or other related field.
Experience or basic understanding of statistics.
Proficiency in data analytics and health outcomes research.
/Anthem, Inc. is ranked as one of America?s Most Admired Companies among health insurers by Fortune magazine and is a 2016 DiversityInc magazine Top 50 Company for Diversity. To learn more about our company and apply, please visit us at EOE. M/F/Disability/Veteran.__/
Job Medical
Title: Pharmacist Clinical or Clinical Pharmacy Analyst, 123392
Location: MA-Andover
Other Locations: CA-Costa Mesa, OH-Mason
Requisition ID: 123392 5f0df23ae41c42f4b7ed1c86451352cb
Company Description:

We recently changed our name from WellPoint to Anthem, Inc., the name people know us by best.  As our companies continue to take a more active role in helping people access the right health care and programs, going by a name that people know and trust is important.

Anthem, Inc. is one of the nation's leading health benefits insurer and a Fortune Top 50 company.  At Anthem, Inc., we are working to transform health care with trusted and caring solutions and meaningfully advance affordability and better health outcomes for our health plan members. Nearly 69 million people are served by our affiliated companies including more than 37 million enrolled in our family of health plans. 

  • One in nine Americans receives coverage for their medical care through Anthem's affiliated plans.

  • We offer a broad range of medical and specialty products.

Bring your expertise to our innovative, achievement-driven culture, and you will discover lasting rewards and the opportunity to help drive the future of health care.

Anthem, Inc. is ranked as one of America’s Most Admired Companies among health insurers by Fortune magazine and is a 2014 DiversityInc magazine Top 50 Company for Diversity.  To learn more about our co

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