Senior Pharmacy Professional

Responsibilities

• Intake pharmacy-related issues from care management teams, independently research and determine solutions, and collaborate with others to implement resolutions.
• Lead the Pharmacy Steering Committee, coordinating monthly meetings with market and enterprise pharmacy leadership, setting agendas, facilitating discussions, and conducting follow-up activities.
• Be a consultant to care management regarding member pharmacy needs.
• Participate in state and federal audits as a subject matter expert related to member eligibility.
• Support transition activities with previous pharmacy benefit manager and other vendors, including prescription file transfers, rebate capture, data error resolution, and compliance with CMS and state requirements.
• Identify pharmacy-related challenges and make recommendations for process improvement.
• Analyze pharmacy utilization data, identify trends, and collaborate with leadership and associates to ensure appropriate referrals and interventions.
• Exercise independent judgment to analyze variable factors using data from a variety of pharmacy sources.
• Develop and utilize pharmacy-related policies, job aids, and training materials.
• Partner with Quality Improvement and Care Management teams to monitor pharmacy Star and HEDIS initiatives.
• Use your skills to make an impact Required Qualifications Bachelor's degree 2 years of data analysis & problem-solving regarding process and workflow concepts 2 years of experience with pharmacy benefits management or pharmacy claims 2 years of demonstrated proficiency in MS Office applications including Excel, Word, PowerPoint
• Visio Preferred Qualifications Experience with process improvement Experience in Medicaid or Medicare Additional Information 8-430 CST Home Travel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be required.
• Scheduled Weekly Hours 40 Pay Range The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting.
• The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc. $71,100 - $97,800 per year This job is eligible for a bonus incentive plan.
• This incentive opportunity is based upon company and/or individual performance.
• Description of Benefits Humana, Inc. and its affiliated subsidiaries (collectively, “Humana”) offers competitive benefits that support whole-person well-being.
• Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work.
• Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.
• About us About Humana: Humana Inc. (NYSE: HUM) is a leading U.S. healthcare company.
• Through our Humana insurance services and our CenterWell healthcare services, we make it easier for the millions of people we serve to achieve their best health – delivering the care and service they need, when they need it.
• These efforts are leading to a better quality of life for people with Medicare and Medicaid, families, individuals, military service personnel, and communities at large.
• Learn more about what we offer at Humana.com and at CenterWell.com.
• Equal Opportunity Employer It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status.
• It is also the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and VEVRAA, to employ and to advance in employment individuals with disability or protected veteran status
• to base all employment decisions only on valid job requirements.
• This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment.