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Business Change Director – CarelonRx PBM Operations Management
Elevance HealthBusiness Change Director leading Medicare Pharmacy Operations at Elevance Health. Guiding benefit configuration and compliance initiatives for Medicare pharmacy benefits.
About the role
Key responsibilities & impact- Serves as the primary Medicare pharmacy benefit SME, partnering with health plan product, clinical, and PBM/vendor teams
- Leads end-to-end benefit build lifecycle including documentation, CMS submission support, configuration logic, testing, validation, and promotion to production
- Identifies potential issues, impacts to adjudication logic, and scope changes
- Leads efforts to identify and implement best practices related to Medicare pharmacy benefit design
- Develops and designs processes and systems for accurate benefit setup
- Designs methods for integrating benefit configuration processes across systems
- Provides process, project, and change management methodology coaching/consulting support
- Leads prioritization and execution of benefit-related initiatives tied to CMS deadlines
Requirements
What you’ll need- Requires a BA/BS in a related field
- minimum of 10 years managing mid to large-scale change/project initiatives
- Deep expertise in Medicare Part D pharmacy benefits including benefit design, formulary strategy, and CMS regulatory requirements
- Strong knowledge of Pharmacy Benefit Manager (PBM) operations, including vendor partnership
- Demonstrated experience supporting CMS audits and ensuring compliance
- Proven ability to interpret complex health plan benefit requirements
- Strong cross-functional leadership experience
- Exceptional strategic thinking, attention to detail, and communication skills
Benefits
Comp & perks- merit increases
- paid holidays
- Paid Time Off
- 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
- financial education resources
ATS Keywords
✓ Tailor your resumeApplicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills & Tools
Medicare pharmacy benefit designbenefit build lifecycledocumentationCMS submission supportconfiguration logictestingvalidationprocess designchange management methodologyformulary strategy
Soft Skills
strategic thinkingattention to detailcommunication skillscross-functional leadershipproject managementcoachingconsultingproblem-solvingprioritizationexecution
Certifications
BA/BS in a related field