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

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