Medicaid Pharmacy Director

Illinois, United States

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Not SpecifiedCompensation

Expert & Leadership (9+ years)Experience Level

Full TimeJob Type

UnknownVisa

Health Insurance, PharmaceuticalsIndustries

Requirements

Candidates must possess a Bachelor's degree in pharmacy or a Doctor of Pharmacy (PharmD) and be an Illinois-licensed pharmacist residing in or willing to relocate to Illinois. A minimum of ten years of pharmacy experience is required, with at least three years in managed care and/or PBM operations. Proven success in cross-team facilitation, consulting, and project management is essential, along with excellent communication skills and proficiency in Microsoft Word, Excel, and PowerPoint. Experience collaborating with staff at all management levels is also necessary.

Responsibilities

The Pharmacy Director will plan, direct, and monitor all financial, operational, professional, and clinical activities for the Humana Illinois FIDE-SNP pharmacy program development. Responsibilities include staying current with state and federal pharmacy regulations, developing corporate communications for senior leadership, and analyzing drug spend and utilization trends. The role involves advising executives on functional strategies, making independent judgments on complex issues, and managing projects collaboratively. This position will also manage the relationship with the internal PBM, ensuring compliance with programmatic requirements, and represent Humana at Pharmacy Medicaid meetings with the Illinois Department of Healthcare and Family Services.

Skills

Managed Care

Pharmacy Benefit Management (PBM)

Drug Development

Clinical Support

Cost Trend Mitigation

Health Outcomes Improvement

Regulatory Compliance

Financial Analysis

Utilization Analysis

Executive Advising

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.

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