Humana Looking For Clinical Pharmacy Lead, Medicare Northeast/Southeast (VA, DC, DE, MD or NC) at Glen Allen, VA Full Time

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 VA or NC

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 (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

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:
For this job, associates are required to be fully COVID vaccinated or undergo weekly COVID testing and wear a face covering while at work. The weekly testing will need to be done through an approved Humana vendor, and unvaccinated associates should follow all social distancing and masking protocols if they are required to come into a Humana facility or work outside of their home. We are a healthcare company committed to putting health and safety first for our members, patients, associates, and the communities we serve.

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 25×10 (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.

If progressed to offer, you will be required to:
Vaccination Info:
Provide proof of full vaccination or commit to testing protocols OR

Provide proof of applicable exemption including any required supporting documentation

Medical, religious, state and remote-only work exemptions are available.

Scheduled Weekly Hours

40