Medicaid Formulary Clinical Pharmacist - CarelonRx

Medicaid Formulary Clinical Pharmacist - CarelonRx

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.

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.

How you will make an impact:

• 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.

Minimum 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).

Preferred Qualifications, Skills, and Experiences:

• 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.

For candidates working in person or virtually in the below location(s), the salary* range for this specific position is $120,540 to $206,640.

Locations: District of Columbia (Washington, DC), Illinois, Maryland, Nevada, New Jersey, New York

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