Formulary Business Analyst II - CarelonRx
About The Position
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 - Health Insurance Exchange 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. How you will make an impact: 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.
Requirements
- Requires a BS/BA degree in related field and a minimum of 2 years related operational and/or data analysis experience, experience in database structures, and standard query and reporting tools; or any combination of education and experience which would provide an equivalent background.
Nice To Haves
- 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.
Responsibilities
- 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.
Benefits
- In addition to your salary, Elevance Health offers benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements).
- 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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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Number of Employees
5,001-10,000 employees
