Pharmacy Claims Professional 2 - Clinical Programs Pharmacy Overutilization Review amp Monitoring

Profile

Description

Be a part of our Pharmacy Claims Professional 2 - Clinical Programs Pharmacy Overutilization Review & Monitoring team. Provide guidance to members who have potential medication over utilization or medication interaction concerns. Your role will be to work within the process parameters to help make connections with health care providers that will guide our members' treatment and ensure medication safety.

Responsibilities

Humana is seeking a Pharmacy Claims Professional 2 - Clinical Programs Pharmacy Overutilization Review & Monitoring

You will share the results of your research and provide analytical support for case reviews by case management. Once approved, you will move forward with any case recommendations and action items.

You will generate and analyze reports related to prescription fills, maintain caseload, prepare cases for case management recommendation, and take case action as directed.

Run reports to support the internal requests for data and analysis as related to medication overutilization as required.

Interface with internal and external resources to ensure successful change in members' medication overutilization or drug seeking behavior.

Coordinate and address any letter communication as directed by case management.

Prepare presentations and communication materials on behalf of the Pharmacy Member Waste and Abuse team.

Coordinate and plan meetings as required.

Required Qualifications

Associate's Degree in Business or a related field, or 1 years of equivalent experience working in a pharmacy claims environment

Comprehensive knowledge of all Microsoft Office applications, including Access, Word, Excel and PowerPoint, workflow management systems

Intermediate to high level of Windows Based system navigation

Strong verbal, written and telephonic communication skills

Strong organizational and time management skills

Previous experience working with data analysis & problem solving skills

Demonstrated ability to manage multiple projects and meet deadlines, and follow in a timely manner

Candidates must reside in Green Bay, WI or Louisville, KY, or within a commutable distance.

Preferred Qualifications

Previous experience with pharmacy claims

Pharmacy Technician Certification/experience

Additional Information

This role will be Work at Home initially but could possibly transition to an office location in the near future.

Must have a private office to protect confidential information

Must have accessibility to high speed DSL or Cable modem for a home office (Satellite internet service is NOT allowed for this role); recommended speed is 10Mx1M

Scheduled Weekly Hours

40

Company info

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