Pharmacy Account Director - CarelonRx Clinical Medicare

Elevance Health • Tampa, FL

5d • Hybrid

About The Position

The Pharmacy Account Director is responsible for developing and maintaining consultative relationships with assigned health plan markets and key stakeholders, serving as a pharmacy subject matter expert with a strong focus on Medicare, Medicare Stars, patient experience, quality, and cost of care. This role monitors pharmacy and market performance, identifies opportunities to improve outcomes and affordability, and translates insights into actionable strategies and initiatives that are driven through implementation and completion.

Requirements

• Requires a BA/BS and a minimum of 5 years of related experience; or any combination of education and experience which would provide an equivalent background.

Nice To Haves

• A Pharmacy License or equivalent service in pharmacy benefit manager is strongly preferred.
• Demonstrated Medicare pharmacy and PBM experience, including strong knowledge of Medicare Advantage, MAPD/PDP, DSNP or other government programs, Medicare Stars and HEDIS, pharmacy quality measures, patient/member experience, benefit design, formulary strategy, utilization management, specialty pharmacy trends, and pharmacy cost drivers is strongly preferred.
• Demonstrated ability to manage a complex pharmacy book of business and support client or market leaders through consultative relationship management, executive-ready insights, issue resolution, program and solution development through implementation, and action planning is strongly preferred.
• Experience translating pharmacy performance data into actionable recommendations across Stars/quality, Cost of Care, spend/trend, utilization, member experience (CAHPS), and market performance, including identifying pharmacy affordability opportunities involving specialty drug trends, high-cost/low-value medications, formulary alternatives, brand/generic mix, member affordability, and savings opportunity sizing is strongly preferred.
• Strong analytical storytelling, critical thinking, project management, and change-management skills, with demonstrated ability to identify performance gaps, develop solutions, drive initiatives and critical milestones through completion, and provide executive presentations with clear recommendations tied to clinical, financial, and operational outcomes is strongly preferred.
• Demonstrated ability to partner across health plan leadership, Quality/Stars, Finance/Actuarial, Product, Compliance, Clinical Operations, Analytics, Member Experience, and Provider Collaboration, combined with strong executive presence, consultative communication, curiosity, accountability, flexibility, and experience using AI, including AI prompt engineering, to support analysis, insights, and business recommendations is strongly preferred.

Responsibilities

• Execute strategic sales and tactical plans by consulting with key decision makers and operational stakeholders in the region.
• Provide ongoing support including opportunity analysis and program development to regional decision makers and support PBM field sales team during RFP processes.
• Assist in the development of recommendations for outcomes-based savings and revenue opportunities.
• Assist operations in developing and implementing key therapeutic programs based on earnings potential.
• Assist in meeting internal health plan goals.

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

What This Job Offers

• Job Type: Full-time
• Career Level: Director