Managed Care Pharmacy Resident

Managed Care Pharmacy Resident

Location: This role requires associates to be in-office 1 - 2days 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.

The Managed Care Pharmacy Resident will be responsible for various operational or clinical aspects of the Carelon Rx pharmacy program, including Prior Authorizations, Medication Therapy Management (MTM), Lock-in, and Drug Utilization Review (DUR) programs.

• 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.
• 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.

• 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 Pharmac

• 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

Elevance Health is a health company dedicated to improving lives and communities – and making healthcare simpler. We are a Fortune 25 company with a longstanding history in the healthcare industry, looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve.

At Elevance Health, we are creating a culture that is designed to advance our strategy but will also lead to personal and professional growth for our associates. Our values and behaviors are the root of our culture. They are how we achieve our strategy, power our business outcomes and drive our shared success - for our consumers, our associates, our communities and our business.

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.

Elevance Health operates in a Hybrid Workforce Strategy. Unless specified as primarily virtual by the hiring manager, associates are required to work at an Elevance Health location at least once per week, and potentially several times per week. Specific requirements and expectations for time onsite will be discussed as part of the hiring process.

The health of our associates and communities is a top priority for Elevance Health. We require all new candidates in certain patient/member-facing roles to become vaccinated against COVID-19 and Influenza. If you are not…