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Evolent Health Clinical Pharmacist in Arlington, Virginia

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; 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.

The Role

Evolent Health is looking for a licensed Clinical Pharmacist 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 a Utilization Management Pharmacist. The Pharmacy team has a blend of responsibilities pertaining to health plan management of the pharmacy benefit across multiple lines of business (Commercial, Exchange, Medicare, and Medicaid). The Clinical Pharmacist – Utilization Management role will support all lines of business via their contribution to the clinical aspects of the Utilization Management (UM) review process. 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.


Pharmacy Utilization Management

  • Support all lines of business via reviewing utilization management requests for drug coverage under both the pharmacy and medical benefits

  • Evaluate requests for both clinical appropriateness and cost effectiveness

  • Coordinate with Pharmacy technicians, Pharmacists, and Medical Directors on UM activities

  • Ensure cases are reviewed in accordance with State and/or Federal guidelines including turnaround time requirements

  • As needed, discuss clinical strategy and decision rationale with prescribers

  • Participate in the quality review and inter-rater reliability processes

Clinical Operations Support

  • Supports P&T process including the development of therapeutic class/drug monographs as needed

  • Research and develop therapy-specific clinical policies and utilization management programs such as Prior Authorization, Step Therapy, Quantity Limit, and/or Coverage Determination programs

  • Support Clinical Operations line of business leaders as needed

  • Support utilization management team projects as needed

Required Qualifications

  • Pharmacy degree; either BS Pharmacy or PharmD

  • 1 year experience coordinating medication selection with prescribers and their care teams

  • Pharmacist license in good standing in state of residence. Willingness to achieve and maintain licensure in multiple states

  • Willing to work evenings and weekends

Preferred Qualifications

  • Experience reviewing and developing medical drug management criteria (i.e., JCode management)

  • 1 year of managed care and/or prior authorization experience

  • 2 years Medicare Advantage health plan pharmacy experience

  • Excellent written and verbal communication skills

Skills and Behavioral Attributes

  • Ability to make independent clinical decisions

  • Committed to team-oriented work environment

  • Exceptional interpersonal, presentation, oral and written communication skills

  • Strong work ethic built on a foundation of proactivity

  • Committed to the practice of inquiry and listening

  • Navigate ambiguity with structured problem-solving and decision-making

  • Analytic with the ability to transform data & trends into actionable insight

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