Manager, Pharmacy Clinical Operations; Clinical Configuration

Manager, Pharmacy Clinical Operations (Clinical Configuration)

Title: Manager, Pharmacy Clinical Operations (Clinical Configuration)
Location(s): Mason, OH, Cincinnati, OH

Hybrid: This role requires associates to be in-office 3 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 if candidates reside within a commuting distance from an office.

Important note: 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.

Carelon Rx is a proud member of the Elevance Health family of companies providing unparalleled level of service in pharmacy benefits. Leveraging new technologies, we actively define our innovative role in the industry.

Build the Possibilities. Make an Extraordinary Impact.

The Manager, Pharmacy Clinical Operations (Clinical Configuration) is responsible for developing and implementing clinical pharmacy programs to promote quality and cost‑effective drug utilization.

• Oversees pharmacist and pharmacy intern associates developing and configuring prior authorization decision trees in the PA workflow tool.
• Oversees associate performance and quality assurance of prior authorization decision trees within the PA workflow tool.
• Provides clinical consulting services to internal partners.
• Assists in implementing clinical programs within the prior authorization space.
• Assists in the development of new clinical products.
• Oversees the Prior Authorization Center.
• Implements new prior authorization programs.
• Manages clinical pharmacy operations and staff to ensure clients’ objectives and deliverables are met.
• Oversees departmental processes, policies and procedures, training, and communication.
• Reports and analyzes prior authorization program trends.
• Ensures achievement of department goals and objectives.
• Hires, trains, coaches, counsels, and evaluates performance of direct reports.
• Provides clinical consulting services to client and implements clinical information and education programs.
• Assists in developing formularies.
• Performs drug utilization analyses.
• Participates in and presents to Pharmacy and Therapeutics (P&T) committee meetings and manages client formulary.

• Requires BA/BS in Pharmacy.
• Minimum of 4 years of experience as a pharmacist in a clinical setting; 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).

Location requirement: Unless expressly allowed by state or federal law, or regulation, must be located in a state or territory of the United States when conducting utilization review or an appeals consideration and cannot be located on a US military base, vessel or any embassy located in or outside of the United States.

For URAC accredited areas, the following professional competencies apply:
Associates in this role are expected to have strong oral, written and interpersonal communication skills, problem‑solving skills, facilitation skills, and analytical skills.

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 deemed to be the property of Elevance Health.

Elevance Health is an Equal Employment Opportunity employer and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws.

Applicants who require accommodation to participate in the job application process may contact elevancehealthj for assistance.

Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state, and local laws, including, but not limited to, the Los Angeles County Fair Chance Ordinance and the California Fair Chance Act.