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. Please note that per our policy on hybrid / virtual work, candidates not within a reasonable commuting distance from the posting location(s) will not be considered for employment, unless an accommodation is granted as required by law. 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.

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.