Senior Clinical Pharmacist

4 weeks ago


Madison, Wisconsin, United States Humana Full time
Job Summary

The Clinical Drug Evaluation and Policy Strategies Senior Clinical Pharmacist Program & Automation Strategy Expert supports government program strategies and evaluates drug policies for clinically appropriate automation opportunities. This role requires a broad understanding of managed care and PBM knowledge to develop and/or implement strategies and programs that balance utilization management administrative costs while maintaining or decreasing drug spend & trend, decreasing member access to care barriers, and improving health outcomes while ensuring clinical and safety parameters are prioritized for the members we serve.

Key Responsibilities
  • Develops and/or maintains clinical strategies (to include automation) related to Drug Denial Lines (DL), Drug Auto Authorization Extension (AAE), Drug Medically Accepted Indication (MAI), Fast Pass (FP), Prior Authorization Hub (PAHub), and Non-Formulary Guide (NFG).
  • Participates in Humana's formulary and Pharmacy and Therapeutics processes.
  • Acts strategically, building trust, driving for excellence, innovating, and implementing/executing projects.
  • Collaborates on research projects and develops proposals for research projects.
  • Supports administrative costs and drug trend management by conducting analysis of drug spend, utilization, and/or approval scenarios.
Requirements
  • Pharmacy degree from an accredited school of pharmacy.
  • Active Pharmacist license with the Board of Pharmacy in the appropriate state.
  • Clinical experience in managed care or other pharmacy-related field.
  • Less than 10% travel requirement, including visits to the home office in Louisville, KY.
Preferred Qualifications
  • BPS Board Certification (any BPS certification).
  • Pharmacoeconomics and Health Outcomes training.
  • Pharmacy practice residency or similar pharmacy practice experience.
  • Knowledge of Medicare and Medicaid as it relates to pharmacy.
  • Six Sigma and/or Project Management Professional certification.


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