Medicare-Medicaid Pharmacy Director

Michigan, United States

Apply with AI Apply

Not SpecifiedCompensation

Expert & Leadership (9+ years)Experience Level

Full TimeJob Type

UnknownVisa

Health Insurance, Managed Care, PharmacyIndustries

Requirements

Candidates must possess a Bachelor's degree in Pharmacy or a Doctor of Pharmacy (PharmD), be a Michigan-licensed pharmacist residing in or willing to relocate to Michigan, and have a minimum of ten years of pharmacy experience, including at least three years in managed care and/or PBM operations. They must also be able to travel 10% of the time, have a successful track record in cross-team facilitation and project management, possess excellent oral and written communication skills, and be proficient in Microsoft Word, Excel, and PowerPoint. Preferred qualifications include a Master's degree in public health or Business Administration, Board Certified Specialty Pharmacist certification, and experience with Microsoft Access, Microsoft Project, and data analytics.

Responsibilities

The Pharmacy Director will plan, direct, and monitor all financial, operational, professional, and clinical activities for the Humana Michigan Medicare-Medicaid health plan's pharmacy program development. Responsibilities include staying current with and implementing State and Federal pharmacy regulations, developing corporate communications for senior leadership, analyzing drug spend and utilization for trend management, advising executives on functional strategies, and exercising independent judgment on complex issues. The role also involves facilitating and consulting across teams, managing projects collaboratively, ensuring compliance with programmatic requirements with the internal PBM, and representing Humana at Pharmacy Medicaid meetings with the Michigan Department of Health and Human Services.

Skills

Managed Care

Pharmacy Benefit Management (PBM)

Drug Development

Clinical Support

Cost Trend Mitigation

Health Outcomes Improvement

Regulatory Compliance

Data Analysis

Financial Analysis

Utilization Analysis

Approval Scenarios

Executive Advising

Strategic Planning

Pharmacy Operations

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