Managed Care Pharmacy Resident at Elevance Health

Mason, Ohio, United States

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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

Prior Authorizations

Medication Therapy Management

MTM

Lock-in

Drug Utilization Review

DUR

Pharmacy and Therapeutics Committee

Therapeutic Class Reviews

Drug Monographs

Formulary Recommendations

Medicaid

Medicare

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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