Hybrid Managed Care Pharmacy Resident

Elevance Health; Mason (OH); Hybrid; USD 60,000 - 72,000; Full time

Job summary

Elevance Health’s CarelonRx is seeking a Managed Care Pharmacy Resident to contribute to operational and clinical aspects such as prior authorizations, MTM, lock-in, and DUR programs.

You will support member care through medication management and participate in a year-long project focused on improving outcomes, with weekly POAs and Medicaid/Medicare determinations in a hybrid work environment.

Qualifications

• PharmD from an accredited school of pharmacy by start date.
• Active, unrestricted state pharmacist license or ability to obtain within 90 days of start date.
• Authorized to work in the U.S. without visa sponsorship requirements
• Completed application including letter of intent and CV
• Three letters of recommendation and official transcripts emailed to [e-mail]

Responsibilities

• Complete work related to 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 aimed at improving member care through proper medication management.
• Perform weekly clinical prior authorizations and coverage determinations for Medicaid and Medicare.
• Participate in pharmaceutical care management through member profiling, recommending lock-in or disease management.
• Respond to and resolve issues related to member/provider complaints, claims processing, and appeals.

Skills

Managed care experience

Excellent communication

Problem solving

Public speaking

Interest in managed care

Education

PharmD from an accredited school of pharmacy

Tools

Microsoft Office

Word

Excel

PowerPoint

Job description

Elevance Health’s CarelonRx is seeking a Managed Care Pharmacy Resident to contribute to operational and clinical aspects such as prior authorizations, MTM, lock-in, and DUR programs.

You will support member care through medication management and participate in a year-long project focused on improving outcomes, with weekly POAs and Medicaid/Medicare determinations in a hybrid work environment.