Clinical Pharmacist- Remote

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. Our pursuit of this mission is the driving force that brings us to work each day. We believe in embracing new ideas, testing ourselves and failing forward. We respect and celebrate individual talents and team wins. We have fun while working hard and Evolenteers often make a difference in everything from scrubs to jeans.

Are we growing? Absolutely. We have seen about 30% average growth over the last three years. Are we recognized? Definitely. We were named one of “Becker’s 150 Great Places to Work in Healthcare” in 2016, 2017, 2018 and 2019 and are proud to be recognized as a leader in driving important Diversity and Inclusion (D&I) efforts: Evolent achieved a 95% score on its first-ever submission to the Human Rights Campaign’s Corporate Equality Index; was named on the Best Companies for Women to Advance List 2020 by Parity.org; and we publish an annual Diversity and Inclusion Annual Report to share our progress on how we’re building an equitable workplace. We recognize employees that live our values, give back to our communities each year, and are champions for bringing our 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.

Evolent Health is looking for a Clinical Pharmacist or Associate Director (depending on prior experience) 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 the Lead of Clinical Operations, including formulary management for Medicaid, Commercial and State Exchange products. This is a remote position, but candidates may be required to travel at times. 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 enjoy working for a collaborative, team-oriented system.

Responsibilities:

Clinical Operations

• Formulary development, clinical utilization strategy and benefit design innovation and integration
• Ownership of PBM oversight to ensure coding updates are accurately made including testing reviews and review of live claims to determine if claims adjudicate as intended at point of sale
• PBM coding issue resolution and process improvements to increase efficiency and accuracy associated with formulary management
• Manage the clinical and operational aspects associated with new and renewing client implementations and reimplementation’s
• State and/or federal submissions and responses to questionnaires, conduct exams, etc.
• Environmental surveillance including monitoring competitor landscapes, regulatory guidance, and published literature for best practices and to ensure clinical guidelines are being considered in the formulary decision making process
• Participate in the development of materials and present updates during P&T to assure industry-leading formulary development delivered through physician engagement and ownership
• Research and develop therapy-specific clinical policies and utilization management programs
• Develop, coordinate and evaluate targeted drug programs, restricted drug programs and drug usage evaluation programs
• Willingness to assist within other areas of pharmacy and support all lines of business, when necessary
• Monitor and track line of business clinical and financial effectiveness; recommend, design, implement and execute strategies for performance improvement and savings initiatives
• Interface with internal and external stakeholders to assure broad collaboration/input and industry-leading solution development
• Work closely with pharmacy leadership to develop and implement clinical strategy
• Take ownership of and participate in additional projects
• Make positive impacts to the team and broader clinical group
• Constant evaluation of opportunities to move the role and team in a positive direction

Utilization Management (UM)

• Conduct utilization reviews (e.g., prior authorization, quantity limit, step therapy) for all lines of business
• Assess clinical appropriateness and cost effectiveness of medications
• Coordinate with pharmacy technicians, pharmacists, and medical directors on UM activities
• Discuss clinical strategy and decision rationale with prescribers
• Participate in UM quality review and inter-rater reliability processes

Client Management

• Increase exposure to day-to-day management and ownership of client account(s), including issue resolution, attending state/federal meetings, and presenting performance metrics and assessments
• Assist with Plan Performance management
• Oversee (and participate as needed) in the client-specific communication process to ensure effective change management
• Provide strategic planning and account management for key accounts
• Maintain ongoing account relationships at multiple levels throughout the customer’s organization
• Provide guidance and client updates to the broader pharmacy team

Qualifications :

Required:

• Pharmacy degree; either BS Pharmacy or PharmD
• Current active pharmacy license in good standing in at least one state; willingness to achieve and maintain licensure in multiple states, if necessary
• A minimum of 2 years clinical pharmacy experience at a health plan or PBM
• Strong interpersonal, oral, and written communication
• Strong work ethic built on a foundation of proactivity
• Ability to navigate ambiguity with structured problem-solving and decision-making

Preferred :

• Previous formulary management experience for Medicaid, State Exchange, Commercial and/or Medicare plans
• Board certification
• Advanced business degree (e.g., MBA, MHA, MPH)
• A minimum of 5 years pharmacy experience, including areas such as health plan pharmacy leadership, clinical utilization management, client services/account management or benefit consulting

Technical requirements:

Currently, Evolent employees work remotely temporarily due to COVID-19. As such, we require that all employees have the following technical capabilities 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

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