Utilization Management Associate Jobs in Brandon, FL

Anticipated End Date:

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Job Description:

Pharmacy Account Director - CarelonRx Clinical Medicare

Location: 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.

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.

The Pharmacy Account Director is responsible for developing and maintaining consultative relationships with assigned health plan markets and key stakeholders, serving as a pharmacy subject matter expert with a strong focus on Medicare, Medicare Stars, patient experience, quality, and cost of care. This role monitors pharmacy and market performance, identifies opportunities to improve outcomes and affordability, and translates insights into actionable strategies and initiatives that are driven through implementation and completion.

How you will make an impact:

• Execute strategic sales and tactical plans by consulting with key decision makers and operational stakeholders in the region.

• Provide ongoing support including opportunity analysis and program development to regional decision makers and support PBM field sales team during RFP processes.

• Assist in the development of recommendations for outcomes-based savings and revenue opportunities.

• Assist operations in developing and implementing key therapeutic programs based on earnings potential.

• Assist in meeting internal health plan goals.

Minimum Requirements:

Requires a BA/BS and a minimum of 5 years of related experience; or any combination of education and experience which would provide an equivalent background.

Preferred Skills, Capabilities, and Experience:

• A Pharmacy License or equivalent service in pharmacy benefit manager is strongly preferred.

• Demonstrated Medicare pharmacy and PBM experience, including strong knowledge of Medicare Advantage, MAPD/PDP, DSNP or other government programs, Medicare Stars and HEDIS, pharmacy quality measures, patient/member experience, benefit design, formulary strategy, utilization management, specialty pharmacy trends, and pharmacy cost drivers is strongly preferred.

• Demonstrated ability to manage a complex pharmacy book of business and support client or market leaders through consultative relationship management, executive-ready insights, issue resolution, program and solution development through implementation, and action planning is strongly preferred.

• Experience translating pharmacy performance data into actionable recommendations across Stars/quality, Cost of Care, spend/trend, utilization, member experience (CAHPS), and market performance, including identifying pharmacy affordability opportunities involving specialty drug trends, high-cost/low-value medications, formulary alternatives, brand/generic mix, member affordability, and savings opportunity sizing is strongly preferred.

• Strong analytical storytelling, critical thinking, project management, and change-management skills, with demonstrated ability to identify performance gaps, develop solutions, drive initiatives and critical milestones through completion, and provide executive presentations with clear recommendations tied to clinical, financial, and operational outcomes is strongly preferred.

• Demonstrated ability to partner across health plan leadership, Quality/Stars, Finance/Actuarial, Product, Compliance, Clinical Operations, Analytics, Member Experience, and Provider Collaboration, combined with strong executive presence, consultative communication, curiosity, accountability, flexibility, and experience using AI, including AI prompt engineering, to support analysis, insights, and business recommendations is strongly preferred.

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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 should submit the following form: Accessibility Accommodation Request Form and a member of the team will be in contact. 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.