Manager, Pharmacy Clinical Operations (clinical Configuration)

Manager, Pharmacy Clinical Operations (Clinical Configuration)

Location(s): Mason, OH, Cincinnati, OH

Hybrid: This role requires associates to be in-office 3 days per week, fostering collaboration and connectivity, while providing flexibility to support productivity and work-life balance. This approach combines structured office engagement with the autonomy of virtual work, promoting a dynamic and adaptable workplace. Alternate locations may be considered if candidates reside within a commuting distance from an office.

Be Part of an Extraordinary Team

CarelonRx is a proud member of the Elevance Health family of companies providing unparalleled level of service in pharmacy benefits. By leveraging the power of new technologies, our strong, clinical-first lens and deep pharmacy expertise, we are actively defining our innovative role in the industry.

Build the Possibilities. Make an Extraordinary Impact.

The Manager, Pharmacy Clinical Operations (Clinical Configuration) is responsible for developing and implementing clinical pharmacy programs to promote quality and cost-effective drug utilization.

How You Will Make an Impact:

1. Oversees pharmacist and pharmacy intern associates developing and configuring prior authorization decision trees in the PA workflow tool.
2. Oversees associate performance and quality assurance of prior authorization decision trees within the PA workflow tool.
3. Provides clinical consulting services to internal partners.
4. Assists in implementing clinical programs within the prior authorization space.
5. Assists in the development of new clinical products.
6. Oversees the Prior Authorization Center.
7. Implements new prior authorization programs.
8. Manages clinical pharmacy operations and staff to ensure clients' objectives and deliverables are met.
9. Oversees departmental processes, policies and procedures, training, and communication.
10. Reports and analyzes prior authorization program trends.
11. Ensures achievement of department goals and objectives.
12. Hires, trains, coaches, counsels, and evaluates performance of direct reports.
13. Provides clinical consulting services to client and implements clinical information and education programs.
14. Assists in developing formularies.
15. Performs drug utilization analyses.
16. Participates in and presents to Pharmacy and Therapeutics (P&T) committee meetings and management of client formulary.

Minimum Requirements:

• Requires BA/BS in Pharmacy.
• Minimum of 4 years of experience as a pharmacist in a clinical setting; 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).

Unless expressly allowed by state or federal law, or regulation, must be located in a state or territory of the United States when conducting utilization review or an appeals consideration and cannot be located on a US military base, vessel or any embassy located in or outside of the United States.

For URAC accredited areas, the following professional competencies apply: Associates in this role are expected to have strong oral, written and interpersonal communication skills, problem-solving skills, facilitation skills, and analytical skills.

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.

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.