Managed Care Pharmacy Resident
About The Position
The Managed Care Pharmacy Resident will be responsible for various operational or clinical aspects of the CarelonRx pharmacy program, including Prior Authorizations, Medication Therapy Management (MTM), Lock-in, and Drug Utilization Review (DUR) programs. 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. CarelonRx (formerly IngenioRx) leverages the power of new technologies and a strong, clinical-first lens, to deliver member-centered, lasting pharmacy care.
Requirements
- PharmD from an accredited school of pharmacy by start date.
- Registered Pharmacist; must possess an active, unrestricted state license to practice pharmacy as an RPh or able to obtain one within 90 days of start date
- Authorized to work in the U.S. without future visa sponsorship requirements
- Completion of application which also includes letter of intent and curriculum vitae (CV)
- Three letters of recommendation and official pharmacy school transcripts emailed directly to [email protected]
Nice To Haves
- Managed care experience; or any combination of education and experience, which would provide an equivalent background
- Familiarity with Microsoft Office Products (Word, Excel, PowerPoint, etc.)
- Excellent communication skills, both written and oral
- Excellent problem-solving, analytical and organizational skills
- Excellent public speaking and presentation skills
- Strong interest in managed care pharmacy
Responsibilities
- Complete work related to the Pharmacy and Therapeutics Committee including therapeutic class reviews, policy review, drug monographs, and formulary recommendations.
- Develop strategies to drive formulary utilization and optimization.
- Complete a year-long project targeted at improving member care through proper medication management.
- Perform weekly clinical prior authorizations and coverage determinations for Medicaid and Medicare.
- Participate in the pharmaceutical care management process through reviewing member profiles, recommending members for lock-in, case management or disease management.
- Respond to and resolve issues related to member/provider complaints, claims processing issues and appeals.
Benefits
- merit increases
- paid holidays
- Paid Time Off
- incentive bonus programs
- medical
- dental
- vision
- short and long term disability benefits
- 401(k) +match
- stock purchase plan
- life insurance
- wellness programs
- financial education resources
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What This Job Offers
Job Type
Full-time
Career Level
Entry Level
Education Level
Ph.D. or professional degree
