Medicare Formulary Strategy Manager

Medicare Formulary Strategy Manager

This role requires associates to be in-office 1 - 2 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. A proud member of the Elevance Health family of companies, CarelonRx leverages the power of new technologies and a strong clinical-first lens, to deliver member-centered, lasting pharmacy care. The Medicare Formulary Strategy Manager will lead the design, development, and execution of formulary strategies for all Group Retiree Solutions (GRS) formularies.

This role requires close collaboration with cross-functional partnersincluding Clinical Pharmacy, Compliance, STARS, Medical Management, Actuary, Product, and Rebate teamsto ensure formularies are clinically appropriate, cost-effective, competitive in the marketplace, and compliant with CMS regulations. The position also provides formulary strategy support across Elevance Health's Medicare Advantage Prescription Drug (MAPD) business.

How You Will Make An Impact

Formulary Development & Strategy

• Lead the annual formulary planning process from kick-off through CMS submission and final approval.
• Develop and execute formulary strategies that balance clinical efficacy, cost-effectiveness, compliance, and competitive positioning.
• Conduct competitive analyses, rebate optimization initiatives, and strategic updates aligned with evolving product and market needs.
• Support the development of tailored formularies for each Medicare product offering.

Group Retiree Solutions (GRS) Clinical Support

Governance & Review

Market Monitoring & Trends

Minimum Requirements

Requires BA / BS in Pharmacy and a minimum of 2 years of managed care pharmacy experience; or any combination of education and experience, which would provide an equivalent background. Current valid active unrestricted state(s) RPH license required.

Preferred Skills, Capabilities and Experiences

Advance degree preferred (PharmD, MBA, MPH, or equivalent). Minimum of 2 years of experience in pharmacy benefit management (PBM), Medicare Part D, or formulary management. Strong understanding of CMS Part D formulary requirements and regulatory guidance. Strong analytical, data interpretation, and trend management skills. Knowledge of STARS measures and their application in formulary strategy. Excellent communication and presentation skills, with the ability to engage leadership and cross-functional stakeholders. Strategic planning and execution within a regulated healthcare environment. Ability to synthesize clinical, financial, and regulatory insights into actionable strategies. Strong analytical and problem-solving abilities. Proven project management skills, including timeline development, prioritization, and cross-functional coordination.

Salary

For candidates working in person or virtually in the below location(s), the salary

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 elevancehealthjobssupport@elevancehealth.com 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.