Manager Pharmacy and Medical Trend

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Job Information

Humana

Manager, Pharmacy and Medical Trend

in

Albuquerque

New Mexico

Description

This leader will oversee a team charged with monitoring, reporting and projecting Humana's drug trends, both pharmacy and medical, as well as the impact of the generic and biosimilar pipeline.

Responsibilities

Be a leader within an interactive team with broad exposure and scope within Humana. Humana is seeking a positive and proactive individual to lead a high performing team that helps translate the clinical into financial to ensure Humana profitability.

Responsibilities

Lead our medical and pharmacy trend process including month over month, quarter over quarter and year over year trend review.

Lead our generic and biosimilar pipeline process.

Produce top quality presentations and reports to be shared with senior leadership such as trend updates, and market event notifications.

Lead the analysis and generation of insights related to medical and pharmacy trends to inform future formulary strategy.

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

Utilize broad understanding of managed care and medical and pharmacy trends to foster the development of strategies to mitigate Humana's cost and trend while improving our member's health.

Partner across Humana to identify and mitigate clinically inappropriate trend in order to maximize value for Humana's members.

Collaborate with pharmacists, business professionals and actuaries in a team environment.

Present confidently to senior leadership on key metrics.

Support clinical research integration activities with internal research department.

Collaborate with other leaders throughout HPS to support formulary strategy and trend initiatives.

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

Invest in the development of associates, and the growth of the team.

Key Competencies:

Acts Strategically

: Has vision, anticipates future consequences and trends accurately; has broad knowledge and perspective; creates competitive and breakthrough strategies and plans.

Leads Change

: Models agility, adaptability and an openness to new ways of thinking and operating. Guides and energizes others to embrace new opportunities arising from change. Inspires strong organizational performance through periods of transformation, ambiguity, and complexity.

Leads Positively

: Leads by example to cultivate a climate of motivation, positive energy and meaning in work. Empowers and guides associates to take personal responsibility, encouraging them to productively learn, flourish, and strengthen team capacity. Assesses, selects, recognizes, and develops diverse talent to capitalize on competencies, ideas and passions.

Drives for Excellence:

You are a continuous learner who encourages others to learn. By constantly upgrading your own work, you achieve results and outperform the competition

Builds Trust

: You honor your word by doing what you say you are going to do

Collaborates:

Engages others by gathering multiple views and being open to diverse perspectives, focusing on a shared purpose that puts Humana's overall success first. Develops and strengthens networks and relationships, both inside and outside the organization, that support company performance. Proactively and transparently contributes information and energy toward creating value with others.

Implementation/Execution:

You are good at organizing and managing multiple priorities and/or projects by using appropriate methodologies and tools. Develops and optimizes end-to-end processes

Problem Solving:

You are a problem solver with the ability to encourage others in collaborative problem solving. Acting as both a broker and consultant regarding resources, you engage others in problem solving without taking over.

Required Qualifications

Degree of Doctor of Pharmacy (PharmD or RPh) from an accredited School of Pharmacy

Active, unrestricted pharmacy licensure

Experience with effectively coaching, developing and leading direct reports and cross-functional teams

Five years clinical experience in managed care or pharmacy related field

Previous experience in trend analysis

Strong track record of driving solutions that achieved clinical and financial outcome

Ability to educate, influence and direct stakeholders on the strategies supporting trend mitigation and (GDR) Generic Dispensing Rate

Preferred Qualifications:

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

Board Certified Pharmacotherapy Specialist (BCPS)

MBA, pharmacoeconomics or health outcomes training

Six Sigma, Lean (or other quality program) background

Previous experience in medical claims analysis

Fine-tuned analytic and strategic thinking capabilities

Experience in finance and/or business related pharmacy practice

Additional Info:

Vaccination Info

Non Patient-facing jobs

We will require full COVID vaccination (https://www.cdc.gov/coronavirus/2019-ncov/vaccines/fully-vaccinated.html) for this job as we are a healthcare company committed to putting health and safety first for our members, patients, associates and the communities we serve.

If progressed to offer, you will be required to provide proof of full vaccination or documentation for a medical or religious exemption consideration where allowed by law. Requests for these exemptions should be submitted at least 2 week prior to your scheduled first day of work.

Patient-facing jobs

We will require full COVID vaccination (https://www.cdc.gov/coronavirus/2019-ncov/vaccines/fully-vaccinated.html) for this job as we are a healthcare company committed to putting health and safety first for our members, patients, associates and the communities we serve. This job must be in the office and requires close personal interaction with patients. You will not be able to social distance.

If progressed to offer, you will be required to provide proof of full vaccination where allowed by law. Medical and religious exemptions will be considered on a case by case basis. Requests for these exemptions should be submitted at least 2 week prior to your scheduled first day of work.

Scheduled Weekly Hours

40

Company info

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