[Hiring] Utilization Management Clinical Pharmacist @Humana

Role Description

The Utilization Management Clinical Pharmacist 2 (VSP/PT) is a clinical pharmacist who completes medical necessity and comprehensive medication reviews for prescriptions requiring pre-authorization. The work assignments are varied and frequently require interpretation and independent determination of the appropriate courses of action.

• Completes a review that includes a full analysis of the medication care plan.
• Investigates overall utilization and identifies unusual usage patterns.
• Intervenes and advises patients and providers to promote cost-effective utilization and quality patient outcomes, as needed.
• Understands department, segment, and organizational strategy and operating objectives, including their linkages to related areas.
• Makes decisions regarding own work methods, occasionally in ambiguous situations, and requires minimal direction.
• Follows established guidelines/procedures.

Qualifications

• Typically requires Bachelor's degree or equivalent and less than 5 years of technical experience.

Requirements

• Work at Home Requirements:
  • Minimum download speed of 25 Mbps and upload speed of 10 Mbps is required.
  • Wireless, wired cable or DSL connection is suggested.
  • Must work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information.
• Travel: Occasional travel to Humana's offices for training or meetings may be required.

Benefits

• Paid time off.
• 401(k) retirement savings plan.
• Employee assistance program.
• Business travel and accident coverage.