Managed Care Pharmacy Resident at Elevance Health

Mason, Ohio, United States

Elevance Health Logo
Not SpecifiedCompensation
Entry Level & New GradExperience Level
Full TimeJob Type
UnknownVisa
Healthcare, PharmacyIndustries

Requirements

  • 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 PharmacyResidency@ElevanceHealth.com
  • Candidates must be within a reasonable commuting distance from the posting location(s), unless an accommodation is granted as required by law

Responsibilities

  • 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
  • Collaborate with account management teams to analyze drug usage data, support initiatives to optimize pharmacy spend and improve member and client outcomes
  • 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
  • Responsible for various operational or clinical aspects of the CarelonRx pharmacy program, including Prior Authorizations, Medication Therapy Management (MTM), Lock-in, and Drug Utilization Review (DUR) programs

Skills

Key technologies and capabilities for this role

Prior AuthorizationsMedication Therapy ManagementMTMLock-inDrug Utilization ReviewDURPharmacy and Therapeutics CommitteeTherapeutic Class ReviewsDrug MonographsFormulary RecommendationsMedicaidMedicare

Questions & Answers

Common questions about this position

What is the work arrangement for this Managed Care Pharmacy Resident 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 be within a reasonable commuting distance from the posting location, unless an accommodation is granted.

What are the minimum requirements for this position?

Candidates need a PharmD from an accredited school of pharmacy by start date, an active unrestricted state pharmacy license or ability to obtain one within 90 days, authorization to work in the U.S. without visa sponsorship, and completion of an application including letter of intent, CV, three letters of recommendation, and official transcripts.

What preferred skills are highlighted for this residency?

Preferred skills include managed care experience or equivalent background, familiarity with Microsoft Office products like Word, Excel, and PowerPoint, excellent written and oral communication skills, and strong problem-solving and analytical abilities.

What does the application process involve for this role?

Submit a completed application including a letter of intent and curriculum vitae (CV), plus three letters of recommendation and official pharmacy school transcripts emailed directly to PharmacyResidency@ElevanceHealth.com.

What is the company culture like at CarelonRx?

CarelonRx emphasizes being part of an extraordinary team, leveraging new technologies and a clinical-first lens to deliver member-centered pharmacy care, with a dynamic workplace combining office collaboration and virtual flexibility.

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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