Medicaid Formulary Pharmacist Clinical - CarelonRx

Overview

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,
Carelon Rx (formerly Ingenio Rx) leverages the power of new technologies and a strong, clinical-first lens, to deliver member-centered, lasting pharmacy care.

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

• 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.

• 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).

• Pharm
  
  D 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.

For candidates working in person or virtually in the below location(s), the salary range for this specific position is $114,800 to $198,030.

Locations:
California;
Cleveland, OH;
District of Columbia (Washington, DC);
Illinois;
Maryland;
Massachusetts;
Nevada;
New Jersey.

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. The salary offered for this specific position is based on a number of legitimate, non-discriminatory factors set by the Company. The Company is committed to equal pay opportunities for equal work regardless of gender, race, or any other category protected by federal, state, and local pay equity laws.

• The salary range is the range Elevance Health in good faith believes is the range of possible compensation for this role at the time of this posting. This range may be modified in the future and actual compensation may vary from posting based on geographic location, work experience, education and/or skill level. No amount is considered to be wages or compensation until such amount is earned, vested, and determinable under the terms and conditions of the applicable policies and plans.
  
  The amount and availability of any bonus, commission, benefits, or any other form of compensation and benefits that are allocable to a particular employee remains in the Company's sole discretion unless and until paid and may be modified at the Company's sole discretion, consistent with the law.

Please be advised that Elevance Health only accepts resumes for compensation from agencies that have a signed agreement with Elevance Health. Any unsolicited resumes, including those submitted to hiring managers, are…