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Medicaid Pharmacy Specialist

2 months ago

Cincinnati, Ohio, United States Elevance Health Full time

Job Overview

Medicaid Pharmacy Specialist - CarelonRx

(Virginia Family Access to Medical Insurance Security Plan)

Location: The ideal candidate will reside within a reasonable distance of one of our designated locations and will engage in a hybrid work model (1-2 days per week in the office).

As a proud member of the Elevance Health family of companies, CarelonRx (formerly IngenioRx) harnesses innovative technologies and a strong clinical focus to provide member-centered, sustainable pharmacy care.

The Pharmacist plays a crucial role in overseeing the selection and use of medications while supporting essential clinical initiatives such as Drug Utilization Review (DUR), Drug Interaction Screening (DIS), and formulary management.

Key Responsibilities:

  • Direct Medicaid formulary management activities.
  • Manage all communications with members, stakeholders, and providers regarding formulary modifications.
  • Ensure correct formulary configurations and claims processing.
  • Act as a clinical pharmacy resource for pharmacy benefit management and operational teams.
  • Guarantee compliance of Medicaid formularies with state and federal regulations and contractual obligations.
  • Investigate and compile detailed clinical information related to pharmaceuticals.
  • Provide clinical support to fellow pharmacists in areas such as prospective, inpatient, and retrospective DURs, along with dosage conversion and therapeutic intervention assistance. Prepare information for network physicians.

Minimum Qualifications:

  • A Bachelor’s degree in Pharmacy is required.
  • At least 2 years of experience in managed care pharmacy (PBM) or a residency in lieu of work experience; or a combination of education and experience that provides an equivalent background.
  • Must be a registered pharmacist.
  • An active, unrestricted state license to practice pharmacy as a Registered Pharmacist (RPh) is required.

Preferred Qualifications, Skills, and Experiences:

  • PharmD is preferred.
  • Experience in Medicaid formulary management is strongly preferred.
  • Excellent oral, written, and interpersonal communication skills, along with strong problem-solving, facilitation, and analytical abilities.
  • Proficiency in Microsoft Excel.

For candidates working in person or remotely, the salary range for this specific position is competitive.

In addition to salary, Elevance Health offers a comprehensive benefits package, including incentive and recognition programs, equity stock purchase options, and 401k contributions (all benefits are subject to eligibility requirements). The salary offered for this position is determined by various legitimate, non-discriminatory factors set by the Company.

Job Level:

Non-Management Exempt

Workshift:

1st Shift (United States of America)

Job Family:

MED > Licensed/Registered Pharmacist

Elevance Health is dedicated to improving lives and communities by simplifying healthcare. We are a Fortune 25 company with a rich history in the healthcare sector, seeking leaders at all levels who are passionate about making a difference for our members and the communities we serve.

Elevance Health is an Equal Employment Opportunity employer, and all qualified applicants will receive consideration for employment without regard to any protected status.