Sr Clinical Pharmacist - Program & Automation Strategy - Humana
Madison, WI
About the Job
Become a part of our caring community and help us put health first
The Clinical Drug Evaluation and Policy Strategies Senior Clinical Pharmacist Program & Automation Strategy Expert supports government program strategies and evaluates drug polices for clinically appropriate automation opportunities. In addition, the Senior Clinical Pharmacist Program & Automation Strategy Expert will provide government program and clinical automation support for internal stakeholders. This position will utilize broad understanding of managed care and PBM knowledge to develop, and/or implement strategies and programs and will be charged to appropriately balance how we mitigate utilization management administrative costs while maintaining or decreasing drug spend & trend, decrease member access to care barriers, and improve health outcomes while ensuring clinical and safety parameters are prioritized for the members we serve. The Senior Clinical Pharmacist Program & Automation Strategy Expert work assignments involve moderately complex to complex issues where the analysis of situations or data requires an in-depth evaluation of variable factors.
The Clinical Drug Evaluation and Policy Strategies Senior Clinical Pharmacist Program & Automation Strategy Expert develops and/or maintains clinical strategies (to include automation) related to Drug Denial Lines (DL), Drug Auto Authorization Extension (AAE), Drug Medically Accepted Indication (MAI), Fast Pass (FP), Prior Authorization Hub (PAHub), and Non-Formulary Guide (NFG). This individual influences the department's strategy for optimizing the utilization management process in balance with mitigating drug utilization trend.
Participate in Humana's formulary and Pharmacy and Therapeutics processes
Acts Strategically: Has vision, anticipates future consequences and trends accurately; has broad knowledge and perspective; creates competitive and breakthrough strategies and plans.
Builds Trust: You honor your word by doing what you say you are going to do.
Drives for Excellence: You are a continuous learner who encourages others to learn. By constantly upgrading your own work, you achieve results and outperform the competition.
Innovates - Introduces or develops new ideas and processes which improve performance or productivity.
Implementation/Execution: You are good at organizing and managing multiple priorities and/or projects by using appropriate methodologies and tools.
Problem Solving: You are a problem solver with the ability to encourage others in collaborative problem solving. Acting as both a broker and consultant regarding resources, you engage others in problem solving without taking over.
Use your skills to make an impact
Required Qualifications
+ Pharmacy degree from an accredited school of pharmacy
+ Must have an active Pharmacist license with the Board of Pharmacy in the appropriate state
+ Complete clinical reviews assessing for appropriate automation opportunities and recommend drug utilization tools to mitigate Humana's cost and trend while improving our member's access to care, health, and costs
+ Serve as a clinical automation and program strategy subject matter expert and provide clinical automation strategy support across Humana
+ Conducts analysis on administrative costs and utilization trends to evaluate and inform strategies
+ Collaborates on research projects and develops proposals for research projects
+ Develops corporate communications to be shared with senior leadership
+ Supports administrative costs and drug trend management by conducting analysis of drug spend, utilization, and/or approval scenarios
+ Makes decisions on moderately complex to complex issues regarding technical approach for project components, and work is performed without direction
+ Exercises considerable latitude in determining objectives and approaches to assignments
+ Clinical experience in managed care or other pharmacy related field
+ Less than 10% travel requirement including visit(s) to home office in Louisville, KY
Preferred Qualifications
+ BPS Board Certification (any BPS certification)
+ Pharmacoeconomics and Health Outcomes training
+ Pharmacy practice residency or similar pharmacy practice experience
+ Knowledge of Medicare and Medicaid as it relates to pharmacy
+ Six Sigma and/or Project Management Professional certification
Additional Information
Interview Format:
As part of our hiring process for this opportunity, we will be using an exciting interviewing technology called Modern Hire to enhance our hiring and decision-making ability. Modern Hire allows us to quickly connect and gain valuable information for you pertaining to your relevant skills and experience at a time that is best for your schedule.
If you are selected for a first round interview, you will receive an email/text correspondence inviting you to participate in a Modern Hire interview. In this interview, you will listen to a set of interview questions over your phone and you will provide recorded responses to each question. You should anticipate this interview to take about 15 minutes. Your recorded interview will be reviewed and you will subsequently be informed if you will be moving forward to next round of interviews.
Alert: Humana values personal identity protection. Please be aware that applicants selected for leader review may be asked to provide a social security number, if it is not already on file. When required, an email will be sent from Humana@myworkday.com with instructions to add the information into the application at Humana's secure website.
Work-At-Home Requirements
WAH requirements: Must have the ability to provide a high speed DSL or cable modem for a home office. Associates or contractors who live and work from home in the state of California will be provided payment for their internet expense.
A minimum standard speed for optimal performance of 25x10 (25mpbs download x 10mpbs upload) is required.
Satellite and Wireless Internet service is NOT allowed for this role.
A dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information
Scheduled Weekly Hours
40
Pay Range
The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc.$112,400 - $154,900 per yearThis job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance.
Description of Benefits
Humana, Inc. and its affiliated subsidiaries (collectively, 'Humana') offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.
About us
About CenterWell Pharmacy: CenterWell Pharmacy provides convenient, safe, reliable pharmacy services and is committed to excellence and quality. Through our home delivery and over-the-counter fulfillment services, specialty, and retail pharmacy locations, we provide customers simple, integrated solutions every time. We care for patients with chronic and complex illnesses, as well as offer personalized clinical and educational services to improve health outcomes and drive superior medication adherence.About CenterWell, a Humana company: CenterWell creates experiences that put patients at the center. As the nation's largest provider of senior-focused primary care, one of the largest providers of home health services, and fourth largest pharmacy benefit manager, CenterWell is focused on whole-person health by addressing the physical, emotional and social wellness of our patients. As part of Humana Inc. (NYSE: HUM), CenterWell offers stability, industry-leading benefits, and opportunities to grow yourself and your career. We proudly employ more than 30,000 clinicians who are committed to putting health first - for our teammates, patients, communities and company. By providing flexible scheduling options, clinical certifications, leadership development programs and career coaching, we allow employees to invest in their personal and professional well-being, all from day one.
Equal Opportunity Employer
It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or veteran status. It is also the policy of Humana to take affirmative action to employ and to advance in employment, all persons regardless of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment.
Humana complies with all applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, sex, sexual orientation, gender identity or religion. We also provide free language interpreter services. See our https://www.humana.com/legal/accessibility-resources?source=Humana_Website.
The Clinical Drug Evaluation and Policy Strategies Senior Clinical Pharmacist Program & Automation Strategy Expert supports government program strategies and evaluates drug polices for clinically appropriate automation opportunities. In addition, the Senior Clinical Pharmacist Program & Automation Strategy Expert will provide government program and clinical automation support for internal stakeholders. This position will utilize broad understanding of managed care and PBM knowledge to develop, and/or implement strategies and programs and will be charged to appropriately balance how we mitigate utilization management administrative costs while maintaining or decreasing drug spend & trend, decrease member access to care barriers, and improve health outcomes while ensuring clinical and safety parameters are prioritized for the members we serve. The Senior Clinical Pharmacist Program & Automation Strategy Expert work assignments involve moderately complex to complex issues where the analysis of situations or data requires an in-depth evaluation of variable factors.
The Clinical Drug Evaluation and Policy Strategies Senior Clinical Pharmacist Program & Automation Strategy Expert develops and/or maintains clinical strategies (to include automation) related to Drug Denial Lines (DL), Drug Auto Authorization Extension (AAE), Drug Medically Accepted Indication (MAI), Fast Pass (FP), Prior Authorization Hub (PAHub), and Non-Formulary Guide (NFG). This individual influences the department's strategy for optimizing the utilization management process in balance with mitigating drug utilization trend.
Participate in Humana's formulary and Pharmacy and Therapeutics processes
Acts Strategically: Has vision, anticipates future consequences and trends accurately; has broad knowledge and perspective; creates competitive and breakthrough strategies and plans.
Builds Trust: You honor your word by doing what you say you are going to do.
Drives for Excellence: You are a continuous learner who encourages others to learn. By constantly upgrading your own work, you achieve results and outperform the competition.
Innovates - Introduces or develops new ideas and processes which improve performance or productivity.
Implementation/Execution: You are good at organizing and managing multiple priorities and/or projects by using appropriate methodologies and tools.
Problem Solving: You are a problem solver with the ability to encourage others in collaborative problem solving. Acting as both a broker and consultant regarding resources, you engage others in problem solving without taking over.
Use your skills to make an impact
Required Qualifications
+ Pharmacy degree from an accredited school of pharmacy
+ Must have an active Pharmacist license with the Board of Pharmacy in the appropriate state
+ Complete clinical reviews assessing for appropriate automation opportunities and recommend drug utilization tools to mitigate Humana's cost and trend while improving our member's access to care, health, and costs
+ Serve as a clinical automation and program strategy subject matter expert and provide clinical automation strategy support across Humana
+ Conducts analysis on administrative costs and utilization trends to evaluate and inform strategies
+ Collaborates on research projects and develops proposals for research projects
+ Develops corporate communications to be shared with senior leadership
+ Supports administrative costs and drug trend management by conducting analysis of drug spend, utilization, and/or approval scenarios
+ Makes decisions on moderately complex to complex issues regarding technical approach for project components, and work is performed without direction
+ Exercises considerable latitude in determining objectives and approaches to assignments
+ Clinical experience in managed care or other pharmacy related field
+ Less than 10% travel requirement including visit(s) to home office in Louisville, KY
Preferred Qualifications
+ BPS Board Certification (any BPS certification)
+ Pharmacoeconomics and Health Outcomes training
+ Pharmacy practice residency or similar pharmacy practice experience
+ Knowledge of Medicare and Medicaid as it relates to pharmacy
+ Six Sigma and/or Project Management Professional certification
Additional Information
Interview Format:
As part of our hiring process for this opportunity, we will be using an exciting interviewing technology called Modern Hire to enhance our hiring and decision-making ability. Modern Hire allows us to quickly connect and gain valuable information for you pertaining to your relevant skills and experience at a time that is best for your schedule.
If you are selected for a first round interview, you will receive an email/text correspondence inviting you to participate in a Modern Hire interview. In this interview, you will listen to a set of interview questions over your phone and you will provide recorded responses to each question. You should anticipate this interview to take about 15 minutes. Your recorded interview will be reviewed and you will subsequently be informed if you will be moving forward to next round of interviews.
Alert: Humana values personal identity protection. Please be aware that applicants selected for leader review may be asked to provide a social security number, if it is not already on file. When required, an email will be sent from Humana@myworkday.com with instructions to add the information into the application at Humana's secure website.
Work-At-Home Requirements
WAH requirements: Must have the ability to provide a high speed DSL or cable modem for a home office. Associates or contractors who live and work from home in the state of California will be provided payment for their internet expense.
A minimum standard speed for optimal performance of 25x10 (25mpbs download x 10mpbs upload) is required.
Satellite and Wireless Internet service is NOT allowed for this role.
A dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information
Scheduled Weekly Hours
40
Pay Range
The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc.$112,400 - $154,900 per yearThis job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance.
Description of Benefits
Humana, Inc. and its affiliated subsidiaries (collectively, 'Humana') offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.
About us
About CenterWell Pharmacy: CenterWell Pharmacy provides convenient, safe, reliable pharmacy services and is committed to excellence and quality. Through our home delivery and over-the-counter fulfillment services, specialty, and retail pharmacy locations, we provide customers simple, integrated solutions every time. We care for patients with chronic and complex illnesses, as well as offer personalized clinical and educational services to improve health outcomes and drive superior medication adherence.About CenterWell, a Humana company: CenterWell creates experiences that put patients at the center. As the nation's largest provider of senior-focused primary care, one of the largest providers of home health services, and fourth largest pharmacy benefit manager, CenterWell is focused on whole-person health by addressing the physical, emotional and social wellness of our patients. As part of Humana Inc. (NYSE: HUM), CenterWell offers stability, industry-leading benefits, and opportunities to grow yourself and your career. We proudly employ more than 30,000 clinicians who are committed to putting health first - for our teammates, patients, communities and company. By providing flexible scheduling options, clinical certifications, leadership development programs and career coaching, we allow employees to invest in their personal and professional well-being, all from day one.
Equal Opportunity Employer
It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or veteran status. It is also the policy of Humana to take affirmative action to employ and to advance in employment, all persons regardless of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment.
Humana complies with all applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, sex, sexual orientation, gender identity or religion. We also provide free language interpreter services. See our https://www.humana.com/legal/accessibility-resources?source=Humana_Website.
Source : Humana
