Medicare-Medicaid Pharmacy Director

Michigan, United States

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Not SpecifiedCompensation

Expert & Leadership (9+ years)Experience Level

Full TimeJob Type

UnknownVisa

Healthcare, Pharmaceuticals, Managed CareIndustries

Requirements

Candidates must possess a Bachelor’s degree in Pharmacy or a Doctor of Pharmacy (PharmD), be a licensed pharmacist in Michigan, and have a minimum of ten years of pharmacy experience, including at least three years in managed care and/or PBM operations. They should also be able to travel up to 10% of the time and demonstrate proficiency in Microsoft Word, Excel, and PowerPoint, along with expertise in collaborative communication and working with diverse teams.

Responsibilities

The Pharmacy Director will oversee all financial, operational, professional, and clinical activities for the Humana Michigan FIDE-SNP health plan pharmacy department, ensuring compliance with legal and accreditation requirements. They will monitor drug spend and utilization, develop strategies to mitigate cost trends and improve health outcomes, coordinate day-to-day pharmacy operations with senior leadership, manage relationships with the internal PBM, Humana Pharmacy Solutions, and represent Humana at pharmacy Medicaid meetings with the Michigan Department of Health and Human Services (MDHHS). Additionally, they will keep current with regulations, develop corporate communications, support trend management through analysis, advise executives, and facilitate collaboration across teams while managing projects.

Skills

Managed Care

PBM (Pharmacy Benefit Management)

Regulatory Compliance

Pharmacy Operations

Drug Spend Analysis

Healthcare Strategy

Clinical Support

Healthcare Regulations

Leadership

Strategic Planning

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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