Clinical Pharmacist - Rx Operations

Your Future Evolves Here

Evolent partners with health plans and providers to achieve better outcomes for people with most complex and costly health conditions. Working across specialties and primary care, we seek to connect the pieces of fragmented health care system and ensure people get the same level of care and compassion we would want for our loved ones.

Evolent employees enjoy work/life balance, the flexibility to suit their work to their lives, and autonomy they need to get things done. We believe that people do their best work when they're supported to live their best lives, and when they feel welcome to bring their whole selves to work. That's one reason why diversity and inclusion are core to our business.

Join Evolent for the mission. Stay for the culture.

What You’ll Be Doing:

Evolent 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’s mission by serving as the lead of formulary management for Medicare, lead of preferred oncology drug list management for Specialty clients, support for Medicaid, Commercial and State Exchange formularies, and other key responsibilities within Pharmacy operations. 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). 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 who enjoy working for a collaborative, team-oriented system.

Collaboration Opportunities:

• Coordinate with pharmacy technicians, Pharmacists, and Medical Directors
• Discuss clinical strategy and decision rationale with prescribers
• Communicate Medicare guidance and updates
• Participate in UM quality review and inter-rater reliability processes
• Client facing subject matter expert for preferred medical oncology drug list and Medicare recommendations
• Work closely with pharmacy leadership to develop and implement clinical strategy

What You Will Be Doing:

• Medicare formulary development and HPMS submission, clinical utilization strategy and benefit design innovation and integration
• Ownership of PBM oversight to ensure coding updates are accurately made including testing reviews and reviews of live claims to determine claims adjudicate as intended at point of sale
• Research and develop therapy-specific clinical policies and utilization management programs
• Participate in the development of materials and present updates during P&T to assure industry-leading formulary development delivered through physician engagement and ownership
• Ability to interpret health plan preferred medical and pharmacy oncology drug coverage
• Medical oncology drug list management and integration into UM platform
• 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

Qualifications Required and Preferred:

• Pharmacy degree: either BS Pharmacy or PharmD- Required
• Current active Pharmacist license in good standing in state of residence. Willingness to achieve and maintain licensure in multiple states, if necessary. -Required
• A minimum of 2 years clinical pharmacy experience at a health plan or PBM or completion of a managed care pharmacy residency program - Required.
• Previous formulary management experience for Medicare plans – Preferred
• Oncology pharmacy experience– Preferred
• Board certification (e.g., BCOP or BCGP) – Preferred
• Experience reviewing and developing drug management criteria– Preferred

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 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. If you need reasonable accommodation to access the information provided on this website, please contact recruiting@evolent.com for further assistance.

The expected base salary/wage range for this position is $120,000. This position is also elig