Managed Care Pharmacy Resident

Elevance Health; Winston-Salem (NC); Hybrid; USD 65,000 - 75,000; Full time

Benefits offered by this job

Medical, dental, vision

401(k) + match

Stock purchase plan

Paid holidays

Wellness programs

Job summary

Elevance Health is seeking a Managed Care Pharmacy Resident to support the CarelonRx pharmacy program, including prior authorizations, MTM, lock-in, and DUR initiatives.

The role emphasizes collaboration and a hybrid work model with in-office days and flexible remote work. Candidates must have a PharmD and be eligible for an active U.S. license.

Qualifications

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

Responsibilities

• Handle weekly clinical prior authorizations and determinations for Medicaid and Medicare.
• Contribute to Pharmacy and Therapeutics Committee reviews and formulary recommendations.
• Develop strategies to drive formulary utilization and optimization.
• Participate in MTM, lock-in, and drug utilization review programs.
• Review member profiles for case management or disease management referrals.
• Address member/provider complaints, claims issues and appeals.

Skills

Managed care experience

MS Office

Communication skills

Problem-solving

Public speaking

Organizational skills

Education

PharmD from an accredited school of pharmacy

Tools

Microsoft Office

Job description

Managed Care Pharmacy Resident

Location:

This role requires associates to be in-office 1 - 2days 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.

Please note that per our policy on hybrid/virtual work, candidates not within a reasonable commuting distance from the posting location(s) will not be considered for employment, unless an accommodation is granted as required by law.

Be Part of an Extraordinary Team

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 Managed Care Pharmacy Resident will be 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.

How you will make an impact:

• 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.
• 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.

Minimum 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 [e-mail]

Preferred Skills, Capabilities and Experiences:

• Managed care experience; or any combination of education and experience, which would provide an equivalent background
• Familiarity with Microsoft Office Products (Word, Excel, PowerPoint, etc.)
• Excellent communication skills, both written and oral
• Excellent problem-solving, analytical and organizational skills
• Excellent public speaking and presentation skills
• Strong interest in managed care pharmacy

Who We Are

Elevance Health is a health company dedicated to improving lives and communities – and making healthcare simpler. We are a Fortune 25 company with a longstanding history in the healthcare industry, looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve.

How We Work

At Elevance Health, we are creating a culture that is designed to advance our strategy but will also lead to personal and professional growth for our associates. Our values and behaviors are the root of our culture. They are how we achieve our strategy, power our business outcomes and drive our shared success - for our consumers, our associates, our communities and our business.

We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few.

Elevance Health operates in a Hybrid Workforce Strategy. Unless specified as primarily virtual by the hiring manager, associates are required to work at an Elevance Health location at least once per week, and potentially several times per week. Specific requirements and expectations for time onsite will be discussed as part of the hiring process.

The health of our associates and communities is a top priority for Elevance Health. We require all new candidates in certain patient/member-facing roles to become vaccinated against COVID-19 and Influenza. If you are not vaccinated, your offer will be rescinded unless you provide an acceptable explanation. Elevance Health will also follow all relevant federal, state and local laws.

Elevance Health is an Equal Employment Opportunity employer and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws. Applicants who require accommodation to participate in the job application process should submit the Accessibility Accommodation Request Form and a member of the team will be in contact.

Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state, and local laws, including, but not limited to, the Los Angeles County Fair Chance Ordinance and the California Fair Chance Act.

Prospective employees required to be screened under Florida law should review the education and awareness resources at HB531 | Florida Agency for Health Care Administration.