Medicaid Formulary Pharmacist Clinical - CarelonRx

Position Overview

Medicaid Formulary Pharmacist Clinical - CarelonRx at Elevance Health is responsible for managing the selection and utilization of pharmaceuticals while supporting clinical programs such as DUR and formulary management. This role requires in-office presence 1–2 days per week and offers structured office engagement alongside the flexibility of virtual work. Candidates must be within a reasonable commuting distance unless an accommodation is granted by law.

Key Responsibilities

• Leads Medicaid formulary management processes.
• Manages all member, stakeholder, and provider communications regarding formulary changes.
• Ensures appropriate formulary set-up and claims adjudication.
• Serves as a clinical pharmacy resource to PBM and pharmacy operations teams, including support for prospective, inpatient, and retrospective DURs.
• Ensures compliance with state/federal mandates and contractual agreements.
• Prepares information for network physicians.

Required Qualifications

• BA/BS in Pharmacy is required.
• Minimum of 2 years of managed care pharmacy (PBM) experience or residency in lieu of work experience (or an equivalent combination of education and experience).
• Must be a registered pharmacist with an active, unrestricted state license to practice as a Registered Pharmacist (RPh).

Preferred Qualifications

• PharmD is strongly preferred.
• Experience in Medicaid formulary management is strongly preferred.
• Strong oral, written, and interpersonal communication skills along with problem-solving, facilitation, and analytical skills.
• Proficiency in Microsoft Excel is desired.
• Experience with Python, SAS, or SQL is a plus.

Benefits & Perks

• Compensation: Salary range of $114,800 to $198,030, subject to adjustments based on geographic location, experience, education, and skill level.
• Benefits: Comprehensive benefits package including medical, dental, vision, short and long term disability insurance, and a 401(k) plan with match.
• Incentive and recognition programs.
• Equity stock purchase plan and additional financial and wellness resources.
• Paid Time Off, paid holidays, and merit increases.