Staff Utilization Management Pharmacist

Position Overview

Become a part of our caring community and help us put health first. The Staff Utilization Management Pharmacist is a clinical pharmacist who completes medical necessity and comprehensive medication reviews for prescriptions requiring pre-authorization. The Staff Utilization Management Pharmacist's work assignments involve moderately complex to complex issues where the analysis of situations or data requires an in-depth evaluation of variable factors.

Schedule

• Able to work 8-hour shifts Monday through Friday between 10:30 AM and 11:00 PM EST OR 10-hour shifts Tuesday through Friday between 10:30 AM and 11:00 PM EST.
• Every 5th Saturday will be required.
• One company holiday will be required in 2025.

Location

• Remote United States

Job Description

The Staff Utilization Management Pharmacist completes a review that includes a full analysis of the medication care plan, investigation of overall utilization, and identification of unusual usage patterns. The Pharmacist intervenes and advises patients and providers to promote cost-effective utilization and quality patient outcomes as needed. Use your skills to make an impact.

Requirements

• Required Qualifications:
  • Bachelor's degree/Pharm.D
  • Must have an active license with the Board of Pharmacy in the state of residence.
  • Pharmacy degree from an accredited college of pharmacy.
  • Ability to participate in Federal prescription programs (Medicare/Medicaid reviews).
  • Self-directed, but also able to work well in a group.
  • Ability to solve problems and encourage others in collaborative problem-solving.
  • Work ethic that is focused, accurate, and highly productive.
  • Strong communication skills.
  • Proficient with computers (various systems).
  • Must be passionate about contributing to an organization focused on continuously improving consumer experiences.
• Preferred Qualifications:
  • Managed care experience - specifically Utilization management review.

Application Instructions

• Interview Format: As part of our hiring process for this opportunity, we will be using an interviewing technology called HireVue to enhance our hiring and decision-making ability. HireVue allows us to quickly connect and gain valuable information from you pertaining to your relevant skills and experience at a time that is best for your schedule.

Company Information

Work From Home (WAH) Requirements:

To ensure Home or Hybrid Home/Office employees’ ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office employees must meet the following criteria:

• At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is recommended.
• Wireless, wired cable, or DSL connection is suggested.
• Satellite, cellular, and microwave connections can be used only if approved by leadership.
• Employees who live and work from home in the state of California, Illinois, Montana, or South Dakota will be provided a bi-weekly payment for their internet expense.
• Humana will provide Home or Hybrid Home/Office employees with telephone equipment appropriate to meet the business requirements for their position/job.
• Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information.

SSN Statement:

Humana values personal identity protection. Please be aware that applicants may be asked to provide their Social Security Number, if it is not already on file. When required, an email will be sent from Humana@myworkday.com with instructions on how to add the information into your official application on Humana’s secure website.

Travel:

While this is a remote position, occasional travel to Humana's offices for training or meetings may be required.

Employment Type

• Full-time

Salary

• Pay Range: $94,900 - $130,500 per year
  • 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.