Join Our Caring Community and Put Health First! As a Utilization Management Clinical Pharmacist, you will play a vital role in ensuring patient safety and medication effectiveness. In this position, you will conduct essential reviews of medication care plans, focusing on medical necessity and comprehensive assessments for prior authorization prescriptions. Your expertise will allow you to evaluate complex clinical scenarios and apply evidence-based guidelines for optimal medication use. Key Responsibilities: Conduct thorough reviews of medication appropriateness and medical necessity. Analyze utilization patterns and identify any unusual trends. Provide clinical guidance and interventions to patients and healthcare providers to facilitate cost-effective medication use. Foster collaborative solutions based on strong problem-solving skills. Qualifications: Bachelor's degree or Doctor of Pharmacy (Pharm.D.) from an accredited pharmacy school . Current pharmacist license in your state of residence . Eligibility for participation in federal prescription programs (e.g., Medicare/Medicaid) . Proactive and capable of working both independently and collaboratively. Exceptional attention to detail and a commitment to accuracy and productivity. Excellent verbal and written communication skills. Proficiency in Microsoft Office Suite, clinical decision support tools, pharmacy benefit management platforms, and electronic health records. Preferred Qualifications: Experience in managed care pharmacy, specifically in utilization management review. Work Environment: This role is remote, allowing you to work from the comfort of your home. Occasional training or meetings may require travel to Humana's offices. Ensure you have a dedicated workspace to protect member PHI/HIPAA information. Compensation and Benefits: The base pay for this position ranges from $104,000 to $143,000 annually, depending on experience and geographic location. Humana offers a comprehensive benefits package, including paid time off, 401(k) retirement savings plan, and more to support your well-being. We Are Committed to Diversity and Inclusion: Humana celebrates diversity and is an equal opportunity employer. We welcome applicants from all backgrounds to join our team and help us further our mission to improve healthcare quality for all.
