Pharmacy Licensing & Credentialing Specialist (Hybrid)

Elevance Health; Florida; Hybrid; USD 52,000 - 76,000; Full time

Job summary

Elevance Health is seeking a Credentialing Analyst Pharmacy in Lake Mary, FL for a hybrid schedule with in-office 1-2 days per week. You will manage license tracking, process license applications, and coordinate credentialing for health plans and PBMs across pharmacy sites.

The role requires a high school diploma and at least 3 years of related experience, with emphasis on policy compliance, confidentiality, and cross-agency collaboration to support timely credentialing.

Qualifications

• Requires a high school diploma and minimum of 3 years' experience; or any combination of education and experience providing an equivalent background.
• Preferred: experience with pharmacy licensure with state boards is strongly preferred.
• Knowledge of Medicaid, Medicare, Managed care and PBM providers is preferred.

Responsibilities

• Manages and maintains pharmacy license tracking tool to advise pharmacy sites and pharmacists of license renewals.
• Submit new pharmacy license applications and renewals for all pharmacy sites.
• Maintains confidentiality of all pertinent pharmacy and provider information.
• Administers credentialing and re-credentialing to ensure compliance with regulatory, accreditation and various managed care plan policies and protocols, standards, and requirements.
• Develops and fosters collaborative relationships with managed care plans, state agencies and PBMs to facilitate timely credentialing and re-credentialing of applications.
• Tracks credentialing and re-credentialing to ensure compliance with time sensitive materials.
• Reviews all credentialing policies and procedures for accuracy and completeness.
• Completes new Medicaid applications and renewals or revalidations.
• Maintain NCPDP profile for all pharmacy sites.
• Certificate of Insurance requests and dissemination to plans or CMS.
• NPI profile updates (NPPES). URAC, ACHC, NABP support during accreditation renewals.
• Submit Pharmacist in Charge state license changes and renewals.

Skills

Pharmacy licensure knowledge

Regulatory compliance

Education

High school diploma

Job description

Elevance Health is seeking a Credentialing Analyst Pharmacy in Lake Mary, FL for a hybrid schedule with in-office 1-2 days per week. You will manage license tracking, process license applications, and coordinate credentialing for health plans and PBMs across pharmacy sites.

The role requires a high school diploma and at least 3 years of related experience, with emphasis on policy compliance, confidentiality, and cross-agency collaboration to support timely credentialing.