Medical Trend - Clinical Pharmacist lead

Profile

Description

The medical utilization management lead will oversee projecting and tracking of medical trend bender strategies, assist with medical strategy value assessments, and support pipeline medical modeling needs. We are seeking a positive and proactive individual to contribute to a high performing team that helps translate the clinical into financial. The goals are to help ensure Humana profitability while improving our member's health and costs. This role functions in a highly collaborative environment across multiple departments to drive results.

Responsibilities

Responsibilities

Oversee forecasting the savings of a medical strategy and tracking actual experience to projection.

Monitor medical utilization management performance by conducting and analyzing drug spend, utilization, and market share evaluation.

Partner with analytics partners to build medical drug/strategy tracking infrastructure to enhance current functionality and support expanded business needs.

Produce top quality presentations and reports and present confidently to senior leadership such as quarterly medical scorecard updates and market event notifications.

Collaborate with key internal stakeholders (e.g., pharmacists, analytics professionals, and actuaries) to deliver on cost-effectiveness savings associated with utilization management edits and programs for medically billed drugs in a team environment.

Lead the analysis and generation of insights related to medical drug utilization and trend to inform future medical strategies that will mitigate Humana's cost and trend while improving our member's health and costs.

Continuously monitors relevant publicly available news/developments in the pharmaceutical sector, performing any ad hoc analyses and generating insights.

Support Pipeline Medical forecasts, with modeling pipeline medical drugs and monitoring in development and new drug approvals, along with research and analysis of emerging experience

Support clinical research integration activities with internal research and analytics departments

Lead multidisciplinary meetings, embracing the keys of Essential Facilitation, to drive to alignment and results.

Required Qualifications

Pharmacy Degree (PharmD or RPh) from an accredited school of pharmacy

Active, unrestricted pharmacy licensure

3 years of experience in in managed care and/or pharmacy related fields

Working knowledge of MS excel, MS PowerPoint required

Strong presentation and critical thinking skills

Self-directed and ability to influence others to achieve goals and meet deadlines

Ability to multi-task and prioritize assignments

Works well independently and within a team setting

Effective project management experience

Preferred Qualifications

Board Certified Pharmacotherapy Specialist (BCPS)

MBA, pharmacoeconomics or health outcomes training

Excellent oral and written communication skills, previous experience presenting and interacting with senior leadership.

Flexible, dynamic personality with a demonstrated ability to lead and influence others without authority while contributing individually.

Previous experience in drug utilization modeling and medical drug reimbursement

Ability to assimilate, analyze, draw conclusions, and make recommendations from complex data.

Additional Information

#LI-Remote

Interview Format:

As part of our hiring process for this opportunity, we will be using an exciting interviewing technology called Modern Hire to enhance our hiring and decision-making ability. Modern Hire allows us to quickly connect and gain valuable information for you pertaining to your relevant skills and experience at a time that is best for your schedule.

If you are selected, you will receive correspondence inviting you to participate in a Modern Hire assessment. You will have a set of questions and you will provide responses to each question. You should anticipate this to take about 15 - 20 minutes. Your answers will be reviewed and you will subsequently be informed if you will be moving forward to next round.

Alert: Humana values personal identity protection. Please be aware that applicants selected for leader review may be asked to provide a social security number, if it is not already on file. When required, an email will be sent from Humana@myworkday.com with instructions to add the information into the application at Humana's secure website.

According to Humana's COVID-19 policy, vaccination and masking is required regardless of vaccination status (with exception for eating and drinking) for associates working in a clinical setting where patients receive care (e.g., pharmacy retail locations, clinics, home care). The policy only requires the primary series alone (first and second vaccine). Boosters are encouraged, but not required. Associates have the option to request an accommodation for medical, religious or other personal needs.

Please note: Some areas of our business, such as the Primary Care Organization including CenterWell, Conviva, Kindred at Home, onehome, SeniorBridge, Neighborhood Centers, Pharmacy Distribution Centers and others, may be required to adhere to federal, state or local or additional workplace guidelines.

Scheduled Weekly Hours

40

Humana complies with all applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, sex, sexual orientation, gender identity or religion. We also provide free language interpreter services. See our https://www.humana.com/legal/accessibility-resources?source=Humana_Website.

Company info

Humana Inc.
Website : http://www.humana.com