Elevance Health-posted 15 days ago
Full-time • Mid Level
Hybrid • Richmond, VA
5,001-10,000 employees
Insurance Carriers and Related Activities

Formulary Business Analyst II - CarelonRx Location: This role requires associates to be in-office 1 - 2 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. A proud member of the Elevance Health family of companies, CarelonRx (formerly IngenioRx) leverages the power of new technologies and a strong, clinical-first lens, to deliver member-centered, lasting pharmacy care. The Business Analyst II will support Clinical Pharmacy Services staff with implementation & maintenance of clinical programs and formularies. Responsible for developing project plans and leading small projects to completion.

  • Acts as liaison with clinical team to coordinate timely and accurate completion of various business deliverables.
  • Maintains clinical formulary/utilization management (prior authorization, step therapy & quantity limits) in web-based formulary management tool, Formulary Navigator.
  • Support communication of clinical program and formulary changes to members and providers as well as internal stakeholders.
  • Support quality assurance processes of clinical programs and formulary strategy
  • Support compliance with PBM Accreditation requirements
  • Support departmental compliance with state and federal regulations.
  • Conducts root cause analysis of processes and issues, identifies, and makes recommendations for improvements, and develops documentation.
  • Communicate plans, status, and issues within the team, group, or project, including business members and management.
  • Requires a BA/BS and minimum of 3 years related business analysis experience, or any combination of education and experience, which would provide an equivalent background. Knowledge of systems capabilities and business operations is strongly preferred.
  • Experience with Excel skills strongly desired.
  • PBM or pharmacy experience (e.g. pharmacy technician, Formulary Product Manager) strongly preferred.
  • Experience with Medicaid formularies preferred.
  • Experience with Python, SAS, or SQL preferred.
  • Formulary Software tool (e.g. Formulary Navigator, RxFlex) experience strongly preferred.
  • We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few.
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