Medicaid Staff Pharmacist

Profile

Description

The Staff Clinical Pharmacist manages the formulary processes for the Clinical Formulary Administration team for the Medicaid LOB. The Staff Clinical Pharmacist work assignments involve moderately complex to complex issues where the analysis of situations or data requires an in-depth evaluation of variable factors.

Responsibilities

Description

Provides clinical operational leadership for build, maintenance, submissions and updates of formularies and drug lists

Ensures accuracy of formularies and utilization management (UM) criteria in the Formulary Enterprise System

Evaluates new medications and accurately incorporates them into Humana's formularies if appropriate

Researches and resolves member benefit inquires

Evaluates UM criteria for step therapy, prior authorization, and dispensing limits

Partners with other stakeholders to operationalize formularies and related products

Actively participants in Pharmacy and Therapeutics Committee and Drug Utilization Review team meetings

Collaborates with other pharmacists and healthcare professionals in a team environment

Manages and communicates line of business priorities

Becomes an expert in Humana's formulary management system and prescription drug data

Performs formulary analysis and reporting

Provides excellent service to our customers and key stakeholders

Develops and leads metrics discussions to deliver process improvements and business results

Creates documented processes and training materials

Key Competencies

Understands clinical data and research, program design, implementation, management and monitoring

Understands Humana's business processes, systems, tools, regulations and structure

Demonstrates appropriate knowledge of company customers and/or business partners and their needs and requirements

Develops and optimizes end-to-end processes

Motivates and inspires associates to higher levels of engagement, productivity and personal achievement

Actively listens and ensures understanding regardless of the communication vehicle

Effectively leverages available resources (financial, people, time) to accomplish objectives

Proactively identifies, evaluates, and solves problems with rigorous logic and a systematic approach

Required Qualifications

Bachelor of Science in Pharmacy or PharmD Degree

Must have an active Pharmacist license with the Board of Pharmacy in the appropriate state

Strong organizational skills and ability to stay on schedule

Proven problem-solving and troubleshooting skills

Ability to work independently and within a team setting to achieve goals and meet deadlines

Excellent verbal and written presentation skills with ability to communicate effectively across all levels of the organization

Ability to take initiative, multi-task, and work in a fast-paced environment

Comprehensive knowledge of Microsoft Office applications, including Word, PowerPoint & Excel

Preferred Qualifications

PharmD

Health Plan experience

Knowledge of Medicare as it relates to pharmacy

Six Sigma and/or Project Management Professional certification

Pharmacy practice residency or similar pharmacy practice experience

Additional Information

Interview Format: As part of our hiring process for this opportunity, we will be using an exciting interviewing technology called Montage Voice to enhance our hiring and decision-making ability. Montage Voice 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.

If you are selected for a first round interview, you will receive an email correspondence (please be sure to check your spam or junk folders often to ensure communication isn't missed) inviting you to participate in a Montage Voice interview. In this interview, you will listen to a set of interview questions over your phone and you will provide recorded responses to each question. You should anticipate this interview to take about 15 to 20 minutes. Your recorded interview will be reviewed and you will subsequently be informed if you will be moving forward to next round of interviews.

Scheduled Weekly Hours

40

Company info

Humana Inc.
Website : http://www.humana.com