Clinical Pharmacy Lead Medicare Northeast/Southeast East Central Region-KY OH IN MI

Profile

Description

The Clinical Pharmacy Lead (CPL) role supports the regional Humana Medicare Advantage Prescription Drug (MAPD) plan for all pharmacy activities and works on problems of diverse scope and complexity ranging from moderate to substantial. The CPL utilizes a utilizes broad understanding of managed care and PBM knowledge to develop, and/or implement strategies and programs to mitigate cost trend and improve health outcomes The Clinical Pharmacy Lead monitors drug development pipeline, and medical literature, while providing clinical support for internal stakeholders.

Responsibilities

Location: work at home anywhere however preference is OH, IN, or MI

The Clinical Pharmacy Lead (CPL) role utilizes a broad range of deep Pharmacy expertise, experience and communication skills to support their assigned Region/territory. The CPL is aligned with, and an integral member of , Regional Stakeholder teams as well as Enterprise Teams and key external Provider Groups and deploys their skills in implementing strategies and programs to mitigate cost trend and improve health outcomes. The CPL Utilizes broad understanding of managed care and PBM knowledge to develop, and/ The Clinical Pharmacy Lead monitors drug development pipeline, and medical literature, while providing clinical support for internal stakeholders.

This role supports the regional Humana Medicare Advantage Prescription Drug (MAPD) plan for all pharmacy activities. In this role you will:


Primary focus of position is the pharmacy subject matter expert, supporting external partners (value based providers systems), and internal partners (**MEMBERS ONLY**SIGN UP NOW***. markets including, but not limited to MAPD lines of business).
Providing financial and utilization analysis to our internal **MEMBERS ONLY**SIGN UP NOW***. markets and external provider systems related to drug trend management
Participating in internal **MEMBERS ONLY**SIGN UP NOW***. divisional and regional committees and relevant operational meetings
Supporting providers with Part B/Part D performance metrics to ensure success as they move along the Path to Value risk continuum.
Provide clinical support to provider systems through operational and executive meetings and various quality provider meetings.
Provide markets/regions with relevant pharmacy related insight into CMS Medicare bid strategy
Creating a high level of engagement with the respective divisional/regional leadership/provider groups/ and Provider Engagement team leadership
Engaging the MAPD markets with Humana Pharmacy Solutions (HPS) programs and leading the pull-through of HPS initiatives
Identifying the new programs and industry best practices that could be considered as part of trends and best practices
Work with internal stakeholders to define appropriate messaging, strategy and data analysis for internal **MEMBERS ONLY**SIGN UP NOW***. markets and external provider systems
Provide expertise and support to internal **MEMBERS ONLY**SIGN UP NOW***. markets and external provider systems related to pharmacy quality and CMS STARS measures


Required Qualifications:


Bachelor's degree in Pharmacy
Must have an active Pharmacist license with the Board of Pharmacy in the appropriate state
Successful track record in facilitating and consulting across teams and managing projects
Thrives in a fast paced, multi-project work environment while still ensuring attention to detail
Excellent communication skills, both oral and written
Proficiency in Microsoft Word, Excel, & PowerPoint
Expertise in working collaboratively and communicating with staff in different positions and all levels of management positions
Experience working with CMS guidelines and Medicare Advantage


Preferred Qualifications:


Pharm D
Master's Degree in Business Administration or a related field
Experience with Microsoft Access & Microsoft Project
Experience with pharmacy benefits and health benefits
Experience working in a Clinical, Long Term care of Inpatient hospital setting


Humana is an organization with careers that change lives-including yours. As an innovator in the fast-paced industry of healthcare, we offer our associates careers that challenge, support and inspire them to use their passion for helping others and to lead their best lives. If you're ready to help people achieve lifelong well-being, and be a part of an organization that is growing and poised to make an impact on the future of healthcare, Humana has the right opportunity for you.

Additional Information:

Work-At-Home Requirements


WAH requirements: Must have the ability to provide a high speed DSL or cable modem for a home office. Associates or contractors who live and work from home in the state of California will be provided payment for their internet expense.
A minimum standard speed for optimal performance of 25x10 (25mpbs download x 10mpbs upload) is required.
Satellite and Wireless Internet service is NOT allowed for this role.
A dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information.


Vaccination Info:

Humana and its subsidiaries require vaccinated associates who work outside of their home to submit proof of vaccination, including COVID-19 boosters. Associates who remain unvaccinated must either undergo weekly negative COVID testing OR wear a mask at all times while in a Humana facility or while working in the field.

Interview Format

As part of our hiring process for this opportunity, we may contact you via text message and email to gather more information using a software platform called Modern Hire. Modern Hire Text, Scheduling and Video technologies allow you to interact with us at the time and location most convenient for you.

If you are selected to move forward from your application prescreen, you may receive correspondence inviting you to participate in a pre-recorded Voice, Text Messaging and/or Video interview. Your recorded interview will be reviewed and you will subsequently be informed if you will be moving forward to next round of interviews.

Alert: Humana values personal identity protection. Please be aware that applicants selected for leader review may be asked to provide a social security number, if it is not already on file. When required, an email will be sent from **** with instructions to add the information into the application at Humana's secure website.

If progressed to offer, you will be required to:

Scheduled Weekly Hours

40

Company info

Sign Up Now - PharmaceuticalCrossing.com