Formulary Business Analyst II - CarelonRx at Elevance Health

Indianapolis, Indiana, United States

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Not SpecifiedCompensation

Mid-level (3 to 4 years)Experience Level

Full TimeJob Type

UnknownVisa

Healthcare, Pharmacy Benefits ManagementIndustries

Requirements

BA/BS degree and minimum of 3 years related business analysis experience, or any combination of education and experience providing an equivalent background
Knowledge of systems capabilities and business operations strongly preferred
Excel skills strongly desired
PBM or pharmacy experience (e.g., pharmacy technician, Formulary Product Manager) strongly preferred
Experience with Medicaid formularies preferred
Experience with Python, SAS, or SQL preferred
Formulary Software tool (e.g., Formulary Navigator, RxFlex) experience strongly preferred
Strong oral, written, and interpersonal communication skills, problem-solving skills, facilitation skills, and analytical skills (for URAC accredited areas)
Must reside within a reasonable commuting distance from the office location (hybrid role requiring 1-2 days in-office per week), unless accommodation granted

Responsibilities

Support Clinical Pharmacy Services staff with implementation and maintenance of clinical programs and formularies
Develop project plans and lead small projects to completion
Act as liaison with clinical team to coordinate timely and accurate completion of various business deliverables
Maintain clinical formulary/utilization management (prior authorization, step therapy, and quantity limits) in web-based formulary management tool, Formulary Navigator
Support communication of clinical program and formulary changes to members, providers, and internal stakeholders
Support quality assurance processes of clinical programs and formulary strategy
Support compliance with PBM Accreditation requirements
Support departmental compliance with state and federal regulations
Conduct root cause analysis of processes and issues, identify and make recommendations for improvements, and develop documentation
Communicate plans, status, and issues within the team, group, or project, including business members and management

Skills

Key technologies and capabilities for this role

Formulary ManagementUtilization ManagementPrior AuthorizationStep TherapyProject ManagementRoot Cause AnalysisBusiness AnalysisPBM AccreditationFormulary Navigator

Questions & Answers

Common questions about this position

What is the work arrangement for this role?

This role requires associates to be in-office 1-2 days per week to foster collaboration, while providing flexibility for virtual work. Candidates must reside within a reasonable commuting distance from an office location, unless an accommodation is granted.

What are the minimum education and experience requirements?

The role requires a BA/BS and a minimum of 3 years of related business analysis experience, or any equivalent combination of education and experience.

What preferred skills are mentioned for this position?

Preferred skills include Excel proficiency, PBM or pharmacy experience, Medicaid formularies experience, Python/SAS/SQL, and experience with formulary software tools like Formulary Navigator or RxFlex.

What communication skills are expected for this role?

Strong oral, written, and interpersonal communication skills are expected, especially in URAC accredited areas.

What experience makes a candidate stand out for this position?

Candidates with PBM or pharmacy experience, knowledge of Medicaid formularies, proficiency in Python/SAS/SQL or Excel, and hands-on experience with formulary software like Formulary Navigator will be strongly preferred.

Elevance Health

Integrated health services and digital platform

About Elevance Health

Elevance Health focuses on enhancing the health of individuals throughout their lives by evolving from a traditional health benefits organization into a comprehensive health partner. The company serves over 118 million people, providing support at every stage of health through an integrated approach that addresses a wide range of health needs. Their services are backed by advanced capabilities and a digital health platform that streamlines access to care. Unlike many competitors, Elevance Health emphasizes a holistic view of health, aiming to redefine health and improve community well-being. The ultimate goal is to make health improvements accessible to everyone.

Indianapolis, IndianaHeadquarters

1944Year Founded

$309.4MTotal Funding

IPOCompany Stage

Enterprise Software, Social Impact, HealthcareIndustries

10,001+Employees

Benefits

Medical, dental, & vision insurance

401(k) + match

Paid holidays

Paid Time Off

Incentive bonus programs

Stock purchase plan

Life insurance

Wellness Programs

Financial education resources

Adoption & Surrogacy Assistance

Dependent-care Flexible Spending Account (DCFSA)

Parental Leave

Parental Transition Week

Critical Caregiving Leave

Risks

Departure of CFO John Gallina may create a gap in financial leadership.

Lawsuit against CMS over MA Star Ratings could lead to financial penalties.

CareBridge integration may face operational challenges, disrupting service delivery.

Differentiation

Elevance Health integrates whole health approach with digital health platform for comprehensive care.

Acquisition of CareBridge enhances home health services within Carelon division.

Strategic partnership with Clayton, Dubilier & Rice aims to innovate primary care delivery.

Upsides

AI integration in home health services can reduce hospital readmissions and improve outcomes.

Predictive analytics support early disease detection, aligning with Elevance's whole health approach.

Telehealth expansion offers opportunities to reach more patients remotely.

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