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
• Provide formulary strategy and clinical support for GRS programs.
• Support GRS product teams, and other internal business partners.
• Research market trends, evaluate competitive positioning, and assess the regulatory landscape to guide GRS clinical program strategies.
• Governance & Review
• Oversee the Pharmacy & Therapeutics (P&T) and Value Assessment Committee (VAC) processes, ensuring evidence-based decision-making and CMS charter compliance.
• Partner with Actuarial teams to model financial scenarios, assess member impact, and evaluate competitive positioning.
• Conduct ongoing and ad hoc reviews focused on specialty tiers, utilization management, STARS performance, and high-cost / high-trend drugs.
• Market Monitoring & Trends
• Monitor emerging drug trends, competitive market dynamics, and utilization patterns to proactively identify opportunities or risks.
• Lead monthly and quarterly analyses of formulary performance, including GLP-1 trend tracking, UM edit evaluations, and tier exception reviews.
• Refine strategy based on real-time market intelligence and performance insights.

Minimum Requirements :

Preferred Skills, Capabilities and Experiences :

For candidates working in person or virtually in the below location(s), the salary range for this specific position is $142,232 to $222,624. Locations : California 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.

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. 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.