Clinical Pharmacist

Elevance Health

Clinical Pharmacist at Elevance Health responsible for managing pharmaceuticals and supporting clinical programs. Collaborating with operations to improve outcomes and ensure compliance in pharmacy management.

Posted 5/14/2026full-timeMason • Florida, Ohio, Texas • 🇺🇸 United StatesJuniorMid-LevelWebsite

About the role

Key responsibilities & impact

Research and synthesize detailed clinical data related to pharmaceuticals
Serves as a clinical resource to other pharmacists on areas such as formulary, utilization management edits, DURs and coordinates with operations team to code programs to meet intent
Leads pharmacy claims adjudication configuration by translating formulary and utilization management requirements into claims processing rules/edits
Interprets and operationalizes Medicaid/state requirements by creating clear clinical criteria and configuration documentation for PA and claims systems; provides independent oversight to ensure consistent, compliant program setup

Requirements

What you’ll need

Requires a BA/BS in Pharmacy
Minimum of 2 years of managed care pharmacy (PBM) experience or residency in lieu of work experience; or any combination of education and experience, which would provide an equivalent background
Requires a registered pharmacist
Current unrestricted Pharmacist license in applicable state(s) required.
PharmD preferred
Demonstrated experience with pharmacy claims processing/adjudication logic and the ability to translate clinical intent into operational outcomes
Proven ability to perform claims configuration/build support
Working knowledge of Medicaid/state program requirements
Experience developing, maintaining, and communicating Prior Authorization clinical criteria
Strong requirements documentation skills
Demonstrated strength in cross-functional collaboration
Ability to work independently, manage multiple concurrent initiatives, and prioritize effectively in a fast-changing environment with minimal supervision
Strong analytical and troubleshooting skills.

Benefits

Comp & perks

merit increases
paid holidays
Paid Time Off
incentive bonus programs
medical
dental
vision
short and long term disability benefits
401(k) +match
stock purchase plan
life insurance
wellness programs
financial education resources

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills & Tools

pharmacy claims processingclaims adjudicationclinical criteria developmentclaims configurationutilization managementformulary managementDURsoperational outcomesrequirements documentationanalytical skills

Soft Skills

cross-functional collaborationindependent workprioritizationtroubleshootingcommunicationorganizational skillsability to manage multiple initiativesfast-changing environment adaptabilityleadershipproblem-solving

Certifications

registered pharmacistPharmDcurrent unrestricted pharmacist license