Health Insurance Exchange Pharmacist - CarelonRx at Elevance Health in Mason, Ohio

Job Description:

Health Insurance Exchange Pharmacist - CarelonRx




Location: The ideal candidate will live within 50 miles of one of our pulse point locations and will work on a hybrid work model (1-2 days per week in the office).


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 Pharmacist is responsible for managing the selection and utilization of pharmaceuticals and supports core clinical programs such as DUR, DIS, and formulary management.



How you will make an impact:

• Lead Health Insurance Exchange formulary management processes.


• Responsible for all member, stakeholder, and provider communications regarding formulary changes.


• Ensure appropriate formulary set-up and claims adjudication.


• Serve as a clinical pharmacy resource to pharmacy benefit management and pharmacy operations teams.


• Ensures compliance with the exchange formularies with state/federal mandates and contractual agreements.


• Researches and synthesizes detailed clinical data related to pharmaceuticals.


• Serves as a clinical resource to other pharmacists in areas such as prospective, inpatient, and retrospective DURs and provides dosage conversion and clinical support for therapeutic interventions. Prepares information for network physicians.

Minimum Requirements:

• Requires BA/BS in Pharmacy.


• Minimum of 2 years of managed care pharmacy (PBM) experience or residency in lieu of work experience; or any combination of education and experience, which would provide an equivalent background.


• Requires a registered pharmacist.


• Must possess an active unrestricted state license to practice pharmacy as a Registered Pharmacist (RPh).

Preferred Qualifications, Skills, and Experiences:

• PharmD preferred.


• Health Insurance Exchange, Marketplace, or ACA experience highly desired.


• Formulary management experience strongly preferred.


• Strong oral, written, and interpersonal communication skills, problem-solving skills, facilitation skills, and analytical skills


• Proficiency in Microsoft Excel

For candidates working in person or remotely in the below location(s), the salary* range for this specific position is $117,600 to $201,600.


Locations: California; Colorado; District of Columbia (Washington, DC); Nevada; New York; Washington State


In addition to your salary, Elevance Health offers benefits such as a comprehensive benefits package, incentive and recognition programs, equity stock purchase, and 401k contribution (all benefits are subject to eligibility requirements). The salary offered for this specific position is based on a number of legitimate, non-discriminatory factors set by the Company. The Company is fully committed to ensuring equal pay opportunities for equal work regardless of gender, race, or any other category protected by federal, state, and local pay equity laws.


* The salary range is the range Elevance Health in good faith believes is the range of possible compensation for this role at the time of this posting. This range may be modified in the future and actual compensation may vary from posting based on geographic location, work experience, education, and/or skill level. Even within the range, the actual compensation will vary depending on the above factors as well as market/business considerations. No amount is considered to be wages or compensation until such amount is earned, vested, and determinable under the terms and conditions of the applicable policies and plans. The amount and availability of any bonus, commission, benefits, or any other form of compensation and benefits that are allocable to a particular employee remains in the Company's sole discretion unless and until paid and may be modified at the Company's sole discretion, consistent with the law. Apply Now