Managed Care Pharmacy Resident
About The Position
Managed Care Pharmacy Resident 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. 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. Be Part of an Extraordinary Team 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 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.
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.
- Collaborate with account management teams to analyze drug usage data, support initiatives to optimize pharmacy spend and improve member and client outcomes.
- 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
- 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
Entry Level
Industry
Insurance Carriers and Related Activities
Education Level
Ph.D. or professional degree
Number of Employees
5,001-10,000 employees
