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What is a CarelonRx job?

A CarelonRx job typically involves roles in pharmacy services, prescription benefit management, and healthcare solutions. Employees may work in areas such as clinical pharmacy, customer support, operations, or data analytics to improve medication access and affordability. CarelonRx is part of Elevance Health, focusing on delivering innovative pharmacy care solutions. Job responsibilities vary based on the specific position, but they generally support optimizing medication management and enhancing patient outcomes.

What are typical daily responsibilities in a pharmacy benefit management role at CarelonRx?

Daily responsibilities in pharmacy benefit management roles at CarelonRx often include processing prescription claims, assisting members with questions about benefits, coordinating with healthcare providers, and ensuring medication authorization processes run smoothly. You may also be involved in reviewing formularies, supporting clinical decision-making, and staying up-to-date with compliance regulations. These tasks require attention to detail and a commitment to customer service, as you play a crucial part in ensuring patients receive timely and accurate medication benefits. Teamwork is common, as professionals frequently collaborate with pharmacists, physicians, and insurance specialists.

What are the key skills and qualifications needed to thrive in the Carelonrx position, and why are they important?

To thrive at CarelonRx in a pharmacy benefit management or clinical support role, you typically need a background in pharmacy, healthcare administration, or a related field, along with relevant licensure or certifications as required. Skills in PBM software platforms, claims processing systems, and familiarity with insurance protocols are essential. Strong communication, analytical thinking, and customer service skills help professionals address both member needs and provider inquiries effectively. Mastery of these competencies ensures accuracy, regulatory compliance, and high-quality service in a fast-paced environment.

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Carelonrx jobs near you
Medical Director Associate - CarelonRx

Medical Director Associate - CarelonRx

Elevance Health

Walnut Creek, CA • On-site

$231K - $396K/yr

Full-time

Medical, Dental, Vision, Life, Retirement, PTO

Posted 21 days ago

Elevance Health rating

7.8

Company rating: 7.8 out of 10

Based on 331 frontline employees who took The Breakroom Quiz

166th of 260 rated insurance

Job description

Anticipated End Date:

2026-06-05

Position Title:

Medical Director Associate - CarelonRx

Job Description:

Medical Director Associate - CarelonRx

Location: This role enables associates to work virtually full-time, with the exception of required in-person training sessions, providing maximum flexibility and autonomy. This approach promotes productivity, supports work-life integration, and ensures essential face-to-face onboarding and skill development. 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. Alternate locations may be considered.

CarelonRx delivers market-leading pharmacy benefit management and medication dispensing services to drive affordability and improve member outcomes.

The Medical Director Associate- CarelonRx supports pharmacy prior authorization reviews to ensure turnaround time is met and we are in compliance with all Pharmacy Benefit Management regulatory requirements.

How you will make an impact:

  • May provide clinical guidance for pharmacy prior authorizations using CarelonRx clinical guidelines.

  • Supports clinicians to ensure timely and consistent responses to members and providers.

  • Conducts peer-to-peer prior authorization reviews for medications with attending physicians or other ordering providers to discuss review determinations.

  • Will participate in a physician on-call weekend rotation for a 24x7 unit.

Minimum Requirements:

  • Requires MD or DO and Board certification approved by one of the following certifying boards is required, where applicable to duties being performed, American Board of Medical Specialties (ABMS) or American Osteopathic Association (AOA).

  • Must possess an active unrestricted medical license to practice medicine or a health profession.

  • 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 US.

  • Minimum of 5 years of clinical experience; or any combination of education and experience, which would provide an equivalent background.

Preferred Qualifications:

  • Utilization management experience preferred.

For candidates working in person or virtually in the below locations, the salary* range for this specific position is $231,504.00 to $396,864.00.

Location(s): California, Nevada, Illinois, Washington state.

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.

* The salary range is the range Elevance Health in good faith believes is the range of possible compensation for this role at the time of this posting. This range may be modified in the future and actual compensation may vary from posting based on geographic location, work experience, education, and/or skill level. Even within the range, the actual compensation will vary depending on the above factors as well as market/business considerations. No amount is wages or compensation until such amount is earned, vested, and determinable under the terms and conditions of the applicable policies and plans. The amount and availability of any bonus, commission, benefits, or any other form of compensation and benefits that are allocable to a particular employee remains in the Company's sole discretion unless and until paid and may be modified at the Company's sole discretion, consistent with the law.

Job Level:

Director Equivalent

Workshift:

1st Shift (United States of America)

Job Family:

MED > Licensed Physician/Doctor/Dentist

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 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.

Prospective employees required to be screened under Florida law should review the education and awareness resources at HB531 | Florida Agency for Health Care Administration.

NOTE: Workday keeps job postings active through 11:59:59 PM on the day before the listed end date. Example: If the end date is 3/13, the posting will automatically come down on 3/12 at 11:59:59 PM. In other words - the job is posted until 3/13, not through 3/13.

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About Elevance Health

Sourced by ZipRecruiter

Elevance Health is a health company dedicated to improving lives and communities - and making healthcare simpler. A Fortune 20 company with a longstanding history in the healthcare industry, we are looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve. You will thrive in a complex and collaborative environment where you take action and ownership to solve problems and lead change. Do you want to be part of a larger purpose and an evolving, high-performance culture that empowers you to make an impact?

Industry

Health care and social assistance

Company size

10,000+ Employees

Headquarters location

Indianapolis, IN, US

Year founded

2004

Social media

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