Manager, Pharmacy Clinical Operations (Prior Authorization)

Anticipated End Date:

2026-02-18

Position Title:

Manager, Pharmacy Clinical Operations (Prior Authorization)

Job Description:

Manager, Pharmacy Clinical Operations

Hybrid: This role requires associates to be in-office 3 days per week, fostering collaboration and connectivity, while providing flexibility to support productivity and work-life balance. This approach combines structured office engagement with the autonomy of virtual work, promoting a dynamic and adaptable workplace. Alternate locations may be considered if candidates reside within a commuting distance from an office.

Please note that per our policy on hybrid/virtual work, candidates not within a reasonable commuting distance from the posting location(s) will not be considered for employment, unless an accommodation is granted as required by law.

The Manager, Pharmacy Clinical Operations responsible for developing and implementing clinical pharmacy programs to promote quality and cost-effective drug utilization.

How you will make an impact:

• Assists in the development of new clinical products.

• Oversees the Prior Authorization Center.

• Implements new prior authorization program.

• Manages clinical pharmacy operations and staff to ensure clients' objectives and deliverables are met.

• Oversees departmental processes, policies and procedures, training, and communication.

• Reports and analyzes prior authorization program trends.

• Ensures achievement of department goals and objectives.

• Hires, trains, coaches, counsels, and evaluates performance of direct reports.

• Provides clinical consulting services to client and implements clinical information and education programs.

• Assists in developing formularies.

• Performs drug utilization analyses.

• Participates in and presents to Pharmacy and Therapeutics (P&T) committee meetings and management of client formulary. 

Minimum Requirements:

• Requires BA/BS in Pharmacy.

• Minimum of 4 years of experience as a pharmacist in a clinical setting; or any combination of education and experience, which would provide an equivalent background.

• Requires a registered pharmacist.

• Must possess an active unrestricted state license to practice pharmacy as a Registered Pharmacist (RPh).

Preferred Qualifications, Skills, and Experiences: 

• Medicaid and Commercial prior authorization reviewing experience.

• Experience optimizing PA intake, review, and follow-up workflows to reduce turnaround time and rework.

• Ability to work effectively on cross-functional teams and values shared accountability/collective success.

• Demonstrated ability to lead teams effectively, including coaching, performance management, and employee engagement.

• Experience with medical injectables.

• Experience with PA Hub.

Unless expressly allowed by state or federal law, or regulation, must be located in a state or territory of the United States when conducting utilization review or an appeals consideration and cannot be located on a US military base, vessel or any embassy located in or outside of the United States.

For URAC accredited areas, the following professional competencies apply: Associates in this role are expected to have strong oral, written and interpersonal communication skills, problem-solving skills, facilitation skills, and analytical skills.

Job Level:

Manager

Workshift:

Job Family:

MED > Licensed/Registered Pharmacist/Pharmacy Technician

Please be advised that Elevance Health only accepts resumes for compensation from agencies that have a signed agreement with Elevance Health. Any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of Elevance Health.

Who We Are

Elevance Health is a health company dedicated to improving lives and communities – and making healthcare simpler. We are a Fortune 25 company with a longstanding history in the healthcare industry, looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve.

How We Work

At Elevance Health, we are creating a culture that is designed to advance our strategy but will also lead to personal and professional growth for our associates. Our values and behaviors are the root of our culture. They are