Medicaid Formulary Pharmacist Clinical - CarelonRx

Elevance Health • Greenfield, OH

10d • Hybrid

About The Position

Medicaid Formulary Pharmacist Clinical - 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. 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 Pharmacist Clinical will be responsible for managing the selection and utilization of pharmaceuticals and supports core clinical programs such as DUR and formulary management.

Requirements

• Requires BA/BS in Pharmacy.
• Minimum of 2 years of managed care pharmacy (PBM) experience or residency in lieu of work experience; or any combination of education and experience, which would provide an equivalent background.
• Requires a registered pharmacist.
• Must possess an active unrestricted state license to practice pharmacy as a Registered Pharmacist (RPh).

Nice To Haves

• PharmD strongly preferred.
• Formulary management experience in Medicaid strongly preferred.
• Strong oral, written, and interpersonal communication skills, problem-solving skills, facilitation skills, and analytical skills.
• Proficiency in Microsoft Excel desired.
• Experience with Python, SAS, or SQL preferred.

Responsibilities

• Leads Medicaid formulary management processes.
• Responsible for all member, stakeholder, and provider communications regarding formulary changes.
• Ensures appropriate formulary set-up and claims adjudication.
• Serves as a clinical pharmacy resource to pharmacy benefit management and pharmacy operations teams.
• Ensures compliance of the Medicaid formularies with state/federal mandates and contractual agreements.
• Serves as a clinical resource to other pharmacists on areas such as prospective, inpatient, and retrospective DURs and provides dosage conversion and clinical support for therapeutic interventions.
• Prepares information for network physicians.

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.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Number of Employees: 5,001-10,000 employees