Pharmacy Account Director - CarelonRx Clinical Medicare

• Execute strategic sales and tactical plans by consulting with key decision makers and operational stakeholders in the region.
  
• Provide ongoing support including opportunity analysis and program development to regional decision makers and support PBM field sales team during RFP processes.
  
• Assist in the development of recommendations for outcomes-based savings and revenue opportunities.
  
• Assist operations in developing and implementing key therapeutic programs based on earnings potential.
  
• Assist in meeting internal health plan goals.
  

• A Pharmacy License or equivalent service in pharmacy benefit manager is strongly preferred.
  
• Demonstrated Medicare pharmacy and PBM experience, including strong knowledge of Medicare Advantage, MAPD/PDP, DSNP or other government programs, Medicare Stars and HEDIS, pharmacy quality measures, patient/member experience, benefit design, formulary strategy, utilization management, specialty pharmacy trends, and pharmacy cost drivers is strongly preferred.
  
• Demonstrated ability to manage a complex pharmacy book of business and support client or market leaders through consultative relationship management, executive-ready insights, issue resolution, program and solution development through implementation, and action planning is strongly preferred.
  
• Experience translating pharmacy performance data into actionable recommendations across Stars/quality, Cost of Care, spend/trend, utilization, member experience (CAHPS), and market performance, including identifying pharmacy affordability opportunities involving specialty drug trends, high-cost/low-value medications, formulary alternatives, brand/generic mix, member affordability, and savings opportunity sizing is strongly preferred.
  
• Strong analytical storytelling, critical thinking, project management, and change-management skills, with demonstrated ability to identify performance gaps, develop solutions, drive initiatives and critical milestones through completion, and provide executive presentations with clear recommendations tied to clinical, financial, and operational outcomes is strongly preferred.
  
• Demonstrated ability to partner across health plan leadership, Quality/Stars, Finance/Actuarial, Product, Compliance, Clinical Operations, Analytics, Member Experience, and Provider Collaboration, combined with strong executive presence, consultative communication, curiosity, accountability, flexibility, and experience using AI, including AI prompt engineering, to support analysis, insights, and business recommendations is strongly preferred.
  

Please be advised that Elevance Health only accepts resumes for compensation from agencies that have a signed agreement with Elevance Health. Any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of Elevance Health.

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 may contact View email address on us.fitly.work for assistance. 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