Clinical Formulary Administration - Group Medicare Lead Pharmacist

Profile

Description

The Group Medicare Clinical Pharmacy Lead 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/or implement strategies and programs to mitigate cost trend and improve health outcomes. The Group Medicare Clinical Pharmacy Lead works on problems of diverse scope and complexity ranging from moderate to substantial.

Responsibilities

The role will include:


Provides clinical operational leadership for build, maintenance, submissions and updates of formularies and drug lists
Ensures accuracy of formularies and utilization management (UM) criteria in the Formulary Enterprise System
Evaluates new medications and accurately incorporates them into Humana's formularies if appropriate
Researches and resolves member benefit inquires
Understanding of UM criteria for step therapy, prior authorization, and dispensing limits
Partners with Group Medicare Pharmacy team to understand client's formulary expectations, operationalize and implement formularies and related products
Actively participants in Pharmacy and Therapeutics Committee and Drug Utilization Review team meetings
Collaborates with other pharmacists and healthcare professionals in a team environment
Manages and communicates line of business priorities
Becomes an expert in Humana's formulary management system and prescription drug data
Performs formulary analysis and reporting
Provides excellent service to our customers and key stakeholders
Develops and leads metrics discussions to deliver process improvements and business results
Creates documented processes and training materials
Leads initiatives Key Competencies

Understands clinical data and research, program design, implementation, management and monitoring
Understands Humana's business processes, systems, tools, regulations and structure
Demonstrates appropriate knowledge of company customers and/or business partners and their needs and requirements
Develops and optimizes end-to-end processes
Motivates and inspires associates to higher levels of engagement, productivity and personal achievement
Actively listens and ensures understanding regardless of the communication vehicle
Effectively leverages available resources (financial, people, time) to accomplish objectives
Proactively identifies, evaluates, and solves problems with rigorous logic and a systematic approach


Required Qualifications


Bachelor of Science in Pharmacy or PharmD Degree
Active pharmacist license in the state(s) in which you are required to practice
Strong organizational skills and ability to stay on schedule
Proven problem-solving and troubleshooting skills
Ability to work independently and within a team setting to achieve goals and meet deadlines.
Ability to take initiative, multi-task, and work in a fast-paced environment
Comprehensive knowledge of Microsoft Office applications, including Word, PowerPoint & Excel


Preferred Qualifications


Excellent verbal and written presentation skills with ability to communicate effectively across all levels of the organization
Previous experience with pharmacy benefits management
Previous Commercial, Medicare and/or Medicaid experience
3 years clinical experience in managed care
Ability to manage end-to-end-processes
Understand Humana's business processes, systems, tools, regulations and structure and how they interrelate to provide products and services that create value for Humana members
Previous management experience and ability to lead teams
Previous program or project management experience
Proven success in leading teams (both direct and indirect) with multiple accountabilities
Excellent data analysis and experience working with Access, SQL and Excel
Lean, 6 sigma experience and/or certification
Previous experience utilizing RX Nova


Additional Information

Scheduled Weekly Hours

40

Company info

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