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The Clinical Drug Evaluation and Policy Strategies Senior Clinical Pharmacist Therapeutic Subject Matter Expert 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 implement strategies and programs to mitigate cost trend and improve health outcomes. The Therapeutic Subject Matter Expert Pharmacist work assignments involve moderately complex to complex issues where the analysis of situations or data requires an in-depth evaluation of variable factors.
The Clinical Drug Evaluation and Policy Strategies Senior Clinical Pharmacist Therapeutic Subject Matter Expert develops, maintains, and operationalizes strategies related to utilization management edits and clinical coverage policies for pharmacy and medically administered drug products. This individual influences the department's strategy.
Participate in Humana's formulary and Pharmacy and Therapeutics processes.
Use your skills to make an impact
Required Qualifications
- Pharmacy degree from an accredited school of pharmacy
- Must have an active Pharmacist license with the Board of Pharmacy in the appropriate state
- BPS Board Certification (any BPS certification)
- Complete clinical reviews, policy development and recommend drug coverage and potential drug utilization tools to mitigate Humana's cost and trend while improving our member's health and costs
- Serve as a clinical subject matter expert and provide clinical support across Humana
- Conducts analysis on drug utilization trends to evaluate and inform formulary strategies.
- Collaborates on research projects and develops proposals for research projects.
- Develops corporate communications to be shared with senior leadership.
- Supports trend management by conducting analysis of drug spend, utilization, and approval scenarios.
- Makes decisions on moderately complex to complex issues regarding technical approach for project components, and work is performed without direction. Exercises considerable latitude in determining objectives and approaches to assignments.
- Clinical experience in managed care or other pharmacy related field
- Less than 10% travel requirement including visit(s) to home office in Louisville, KY
Preferred Qualifications
- 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
Scheduled Weekly Hours
40
Pay Range
$112,400 - $154,900 per year. This job is eligible for a bonus incentive plan based upon company and/or individual performance.
Description of Benefits
Humana, Inc. and its affiliated subsidiaries offer competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work.
About us
About CenterWell Pharmacy: CenterWell Pharmacy provides convenient, safe, reliable pharmacy services and is committed to excellence and quality. We care for patients with chronic and complex illnesses, as well as offer personalized clinical and educational services to improve health outcomes and drive superior medication adherence.
Equal Opportunity Employer
It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or veteran status.
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