Become a part of our caring community and help us put health first
 

The Senior Pharmacy Contracting Professional understands pharmacy network business processes and works with the department to meet Medicare, Medicaid, and state compliance requirements and engages with business partners for the Pharmacy Networks and Contracting Team. The role will also be responsible for being a point-of-contact during audits and tracking action items to completion. The Senior Pharmacy Contracting Professional work assignments involve moderately complex to complex issues where the analysis of situations or data requires an in-depth evaluation of variable factors.

The Senior Pharmacy Contracting Professional is responsible for reviewing state legislation and federal regulations to ensure contracts, policies and procedures are compliant. Manages the oversight of process implementation and issue resolution by working with business stakeholders and appropriate Compliance representatives. Point-of-contact for Pharmacy Networks and Compliance for audits and is responsible for tracking open items through resolution. Works with ESP and PRIME. Requires cross-departmental collaboration and maintains frequent contact with business partners across the organization.

Key Responsibilities

• Understand the impacts of new federal or state guidance and/or legislation on the pharmacy network and contracts
• Corrective action/plan development: partner with business stakeholders to implement corrective actions and process improvements
• Understand the pharmacy networks, their purpose, and impacts on other business processes and areas
• Demonstrate a comprehensive understanding of the relationship between business needs and appropriate solutions
• Close process gaps identified by Compliance
• Use inquisitive, forward-looking, big picture thinking to improve processes and business outcomes
• Influence others to gain support for initiatives or changes that will close gaps and/or improve business outcomes
• Establish solid relationships with business groups in order to influence and understand on-going business needs

Use your skills to make an impact
 

Required Qualifications

• Bachelor's Degree
• 3 or more years experience in pharmaceutical industry or compliance related role
• Strong business acumen with proficiency in analyzing and interpreting legislation, regulation, and contracts
• Ability to manage multiple tasks and deadlines with attention to detail
• Ability to communicate effectively and deliver presentations to senior management
• Able to give direction and make sound business decisions
• Must be passionate about contributing to an organization focused on continuously improving consumer experiences

Preferred Qualifications

• Process improvement experience

Additional Information

Travel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be required.

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.

 

$78,400 - $107,800 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.<