Senior Pharmacy Professional

🔥 0 minutes ago

🧀 Wisconsin – Remote

🧀 Wisconsin – Remote

💵 $71.1k - $97.8k / year

⏰ Full Time

🟠 Senior

💊 Pharmacist

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Humana

WebsiteLinkedInAll Job Openings

10,000+ employees

Founded 1961

⚕️ Healthcare Insurance

Healthcare Insurance

Humana is a healthcare company dedicated to making a positive impact on the health of individuals, communities, and the healthcare system as a whole. With a focus on putting health first, Humana serves a diverse range of populations, including seniors and the military, providing Medicare Advantage HMO, PPO, and PFFS plans. Humana is committed to fostering a culture of belonging and mutual respect, offering competitive and flexible benefits to ensure the financial security of its employees and their families. The company prides itself on creating an inclusive workplace where everyone has the opportunity to succeed.

📋 Description

• Intake pharmacy-related issues from care management teams, independently research and determine solutions, and collaborate with others to implement resolutions. • Lead the Pharmacy Steering Committee, coordinating monthly meetings with market and enterprise pharmacy leadership, setting agendas, facilitating discussions, and conducting follow-up activities. • Be a consultant to care management regarding member pharmacy needs. • Participate in state and federal audits as a subject matter expert related to member eligibility. • Support transition activities with previous pharmacy benefit manager and other vendors, including prescription file transfers, rebate capture, data error resolution, and compliance with CMS and state requirements. • Identify pharmacy-related challenges and make recommendations for process improvement. • Analyze pharmacy utilization data, identify trends, and collaborate with leadership and associates to ensure appropriate referrals and interventions. • Exercise independent judgment to analyze variable factors using data from a variety of pharmacy sources. • Develop and utilize pharmacy-related policies, job aids, and training materials. • Partner with Quality Improvement and Care Management teams to monitor pharmacy Star and HEDIS initiatives.

🎯 Requirements

• Bachelor's degree • 2 years of data analysis & problem-solving regarding process and workflow concepts • 2 years of experience with pharmacy benefits management or pharmacy claims • 2 years of demonstrated proficiency in MS Office applications including Excel, Word, PowerPoint, and Visio

🏖️ Benefits

• medical, dental and vision benefits • 401(k) retirement savings plan • time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave) • short-term and long-term disability • life insurance