The Clinical Pharmacy Lead monitors drug development pipeline, and medical literature, while providing clinical support for internal stakeholders. 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 works on problems of diverse scope and complexity ranging from moderate to substantial.
Location: work at home Alabama only
This role supports the regional Humana Medicare Advantage Prescription Drug (MAPD) plan for all pharmacy activities. It does this through the following:
- Primary focus of position is the pharmacy subject matter expert, supporting external partners (value based providers systems), and internal partners (Humana Inc. markets including, but not limited to MAPD lines of business).
- Providing financial and utilization analysis to our internal Humana Inc. markets and external provider systems related to drug trend management
- Participating in internal Humana Inc. 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 Humana Inc. markets and external provider systems
- Provide expertise and support to internal Humana Inc. markets and external provider systems related to pharmacy quality and CMS STARS measures
- Degree in Pharmacy and activePharmacy licensein good standing
- 5 years or more of pharmacy experience, or equivalent residency experience
- Knowledge of pharmacy practice and the cost drivers of pharmacy with providers and systems
- Successful track record in facilitating and consulting across teams and managing projects
- Ability to work independently under general instructions and to develop cross functional relationships across multipleoperational departments
- Excellent communication skills, both oral and written
- Proficiency in Microsoft Applications including Word, Excel, & Power Point
- MBA, or Pharmacy related business experience in and out of managed care environment
- Prior experience in the insurance industry or Medicare Advantage or Managed care world
- Provider facing experience
- Familiarity with Pharmacy utilization, spend and trend financials
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.
Scheduled Weekly Hours