Medicare Formulary Strategy Manager

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Job Description:

Medicare Formulary Strategy Manager

Hybrid 1: 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 (formerly IngenioRx) 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 Healths 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:

• 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.

For candidates working in person or virtually in the below location(s) the salary* range for this specific position is $142232 to $222624.

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.

*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 considered to be 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 paid time off stock or any other form of compensation and benefits that are allocable to a particular employee remains in the Companys sole discretion unless and until paid and may be modified at the Companys sole discretion consistent with the law.

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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 may contact 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.