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The Supervisor, Utilization Management Pharmacy is a clinical pharmacist who leads a team of pharmacists who perform medical necessity reviews for prescriptions requiring pre-authorization. The Supervisor, Utilization Management Pharmacy works within thorough, prescribed guidelines and procedures using independent judgment requiring analysis of variable factors to solve basic problems. They collaborate with management and top professionals/specialists in selection of methods, techniques, and analytical approach.
The Supervisor, Utilization Management Pharmacy leads of team of pharmacists. This team of pharmacists complete utilization management reviews that use clinical judgement, policy, and compendia to render accurate coverage decisions. This role requires cross-team partnership in multiple functional areas including but not limited to strategy, workforce management, and IT. Decisions are typically are related to schedule, plans and daily operations. This associate performs escalated or more complex work of a similar nature, and supervises a group of typically support and technical associates by coordinating and providing day-to-day oversight to associates. They ensure consistency in execution across team through monitoring of efficiency and quality.
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Required Qualifications
- Must have an active license with the Board of Pharmacy in the appropriate state
- Pharmacy degree from an accredited college of pharmacy
- 1+ years of experience utilizing PAHub, CGX, and RXNova
- Self-directed, but also able to work well in a group
- Ability to solve problems and encourage others in collaborative problem solving
- Work ethic that is focused, accurate, and highly productive
- Excellent communication skills
- Home Office : a dedicated secure home workspace, and high-speed internet (minimum download speed of 25 Mbps and upload of 10 Mbps)
Preferred Qualifications
- 1+ years of direct leadership experience
- 1+ years of experience with Information Technology (IT) product design
Additional Information
Home Office Requirements and Information:
- At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is recommended
- Wireless, wired cable or DSL connection is suggested. Satellite, cellular and microwave connection can be used only if approved by leadership
- Humana will provide Home or Hybrid Home/Office employees with telephone equipment appropriate to meet the business requirements for their position/job.
- Must work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information
Virtual Pre-Screen:
As part of our hiring process for this opportunity, we will be using exciting virtual pre-screen technology called HireVue to enhance our hiring and decision-making ability. HireVue allows us to quickly connect and gain valuable information for you pertaining to your relevant skills and experience at a time that is best for your schedule. If you are selected for a virtual pre-screen, you will receive an email and text correspondence inviting you to participate in a HireVue interview. You should anticipate this virtual pre-screen to take about 10-15 minutes.
Personal Identity Protection
Humana values personal identity protection. Please be aware that applicants may be asked to provide their Social Security Number, if it is not already on file. When required, an email will be sent from Humana@myworkday.com with instructions on how to add the information into your official application on Humana's secure website.
This is a remote position
#LI-Remote
Scheduled Weekly Hours
40
Pay Range
The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc.
$112,400 - $154,900 per year
This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance.
Description of Benefits
Humana, Inc. and its affiliated subsidiaries (collectively, "Humana") offers 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. Among our benefits, Humana provides 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 and many other opportunities.
About us
Humana Inc. (NYSE: HUM) is committed to putting health first - for our teammates, our customers and our company. Through our Humana insurance services and CenterWell healthcare services, we make it easier for the millions of people we serve to achieve their best health - delivering the care and service they need, when they need it. These efforts are leading to a better quality of life for people with Medicare, Medicaid, families, individuals, military service personnel, and communities at large.
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 because he or she is a protected veteran. It is also the policy of Humana to take affirmative action to employ and to advance in employment, all persons regardless of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment.