Staff Utilization Management Pharmacist (VSP/PT)

San Antonio, Texas, United States

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Not SpecifiedCompensation

Mid-level (3 to 4 years), Senior (5 to 8 years)Experience Level

Part TimeJob Type

UnknownVisa

Healthcare, Pharmaceuticals, InsuranceIndustries

Requirements

Candidates must possess a Bachelor's degree or Doctor of Pharmacy (Pharm.D.) from an accredited college of pharmacy and hold an active pharmacist license in their state of residence. Eligibility to participate in federal prescription programs, strong problem-solving skills, high attention to detail, and proficiency with computer systems including Microsoft Office Suite, clinical decision support tools, pharmacy benefit management platforms, and electronic health records are required. Experience in managed care pharmacy, particularly in utilization management review, is preferred.

Responsibilities

The Staff Utilization Management Pharmacist is responsible for conducting comprehensive medication reviews, including evaluating medical necessity, analyzing overall utilization, and identifying unusual usage patterns. This role involves applying evidence-based criteria to ensure appropriate medication use, addressing complex clinical scenarios, and intervening to provide clinical guidance to patients and providers for cost-effective medication use and optimal patient outcomes.

Skills

Utilization Management

Medication Reviews

Prior Authorization

Clinical Scenarios

Evidence-based Criteria

Critical Thinking

Problem-Solving

Attention to Detail

Communication

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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