Staff Utilization Management Pharmacist

About the Role

Become a part of our caring community and help us put health first. The Staff Utilization Management Pharmacist is a clinical expert responsible for conducting medical necessity and comprehensive medication reviews for prescriptions requiring prior authorization. This role involves evaluating complex clinical scenarios and applying evidence-based criteria to ensure appropriate medication use. The pharmacist addresses moderately complex to complex issues that require critical thinking and in-depth analysis of variable factors.

Location & Schedule

• Location: Remote – United States
• Schedule:
  • 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
• Required: To work every 5th Saturday
• Required: To work 1 company holiday in 2025

Job Description

The Staff Utilization Management Pharmacist is a clinical professional responsible for conducting comprehensive reviews of medication care plans. This includes evaluating medical necessity, analyzing overall utilization, and identifying unusual usage patterns. The pharmacist may intervene and provide clinical guidance to patients and providers to support cost-effective medication use and promote high-quality patient outcomes. Use your skills to make an impact.

Required Qualifications

• Education: Bachelor’s degree or Doctor of Pharmacy (Pharm.D.) from an accredited college of pharmacy
• License: Active pharmacist license in the state of residence
• Eligibility: Eligibility to participate in federal prescription programs (e.g., Medicare/Medicaid)
• Work Style:
  • Self-directed with the ability to work effectively both independently and in a team environment
  • High attention to detail with a strong work ethic focused on accuracy and productivity
• Skills:
  • Strong problem-solving skills and the ability to foster collaborative solutions
  • Excellent verbal and written communication skills
• Technical Proficiency:
  • Microsoft Office Suite (Word, Excel, Outlook)
  • Clinical decision support tools (e.g., Micromedex, Lexicomp)
  • Pharmacy benefit management (PBM) platforms
  • Electronic health records (EHRs)
• Motivation: Passion for contributing to an organization focused on continuously improving the consumer experience

Preferred Qualifications

• Experience in managed care pharmacy, particularly in utilization management review.

Additional Information

• 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.

Work From Home (WAH) Requirements

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

Social Security Number (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.