Medicaid Drug Strategy Pharmacist Lead

San Antonio, Texas, United States

Apply with AI Apply

Not SpecifiedCompensation

Expert & Leadership (9+ years)Experience Level

Full TimeJob Type

UnknownVisa

Health Insurance, Managed CareIndustries

Requirements

Candidates must possess a Pharmacy Degree from an accredited School of Pharmacy, with at least 3 years of clinical experience in managed care or a related pharmacy field. Essential skills include strong analytical and problem-solving abilities, excellent communication for presenting to senior leadership, and proficiency in Microsoft Office Suite (Powerpoint, Excel, Word). Experience in building new processes, developing infrastructure, prioritizing tasks, and effective time management is also required. Preferred qualifications include BPS Board Certification, pharmacy practice residency, knowledge of Medicaid pharmacy regulations, and experience in formulary development.

Responsibilities

The Medicaid Drug Strategy Pharmacist Lead will develop and implement drug strategies for the Medicaid line of business to mitigate costs and improve health outcomes, utilizing clinical and financial data. This role involves analyzing market and regulatory insights to support formulary and medical drug strategy development, ensuring alignment with guiding principles and state requirements. Responsibilities include translating complex information into clear, data-driven messages for executive audiences, collaborating across departments for strategy decisions and implementation, and leveraging market trends for strategic planning. The lead will also manage moderately complex to complex issues with minimal direction, exercising considerable latitude in determining approaches to assignments.

Skills

Pharmacy

Managed Care

PBM

Market Insights

Regulatory Insights

Drug Strategy Development

Cost Mitigation

Health Outcomes Improvement

Clinical Data Analysis

Financial Data Analysis

Formulary Management

Medical Drug Strategy

Communication

Data-Driven Messaging

Cross-functional Collaboration

Market Trend Analysis

Competitive Intelligence

Humana

Health insurance provider for seniors and military

About Humana

Humana provides health and well-being services, focusing on Medicare Advantage plans for seniors, military personnel, and communities. Their plans include HMO, PPO, and PFFS options, designed to improve health outcomes through comprehensive and flexible coverage. Humana's revenue comes from government contracts and member premiums, and they aim to maintain high renewal rates by offering quality service and competitive benefits. The company stands out by fostering a culture of inclusivity and belonging among its employees, while also ensuring accessibility for all members, including offering free language interpreter services. Humana's goal is to deliver value to its members through an extensive provider network and innovative health solutions.

Louisville, KentuckyHeadquarters

1961Year Founded

IPOCompany Stage

Social Impact, HealthcareIndustries

10,001+Employees

Risks

Potential over-reliance on AI could disrupt operations if systems fail or are compromised.

Rising medical costs and tightening Medicare reimbursements may strain financial performance.

Leadership change with new CEO Jim Rechtin could lead to strategic disruptions.

Differentiation

Humana is a leader in Medicare Advantage plans, focusing on seniors and military personnel.

The company emphasizes inclusivity, offering free language interpreter services for accessibility.

Humana leverages AI and cloud technologies through a partnership with Google Cloud.

Upsides

Humana's investment in Healthpilot enhances digital enrollment for Medicare options.

The company is the first insurer to cover TMS therapy for adolescent depression.

Humana's focus on value-based care aims to improve outcomes for kidney disease patients.

Land your dream remote job 3x faster with AI

Try Jobo Free