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The Staff Utilization Management Pharmacist (VSP/PT) is a clinical expert responsible for conducting medical necessity and comprehensive medication reviews for prescriptions requiring prior authorization. This role involves evaluating complex clinical scenarios and applying evidence-based criteria to ensure appropriate medication use. The pharmacist addresses moderately complex to complex issues that require critical thinking and in-depth analysis of variable factors.

Location: Remote – United States

Schedule: This is a VSP (Variable Service Provider) role. The hours will vary between 24-40 hours per week.

The shift for training will be 10:00AM-630PM ET.

After training, a shift of either 11:00AM-730PM ET, 12:00PM-830PM, or 1:00PM-930PM will be assigned based on business need. Some weekend coverage may be required. Mandatory overtime during peak season.

Job Description:

The Staff Utilization Management Pharmacist (VSP/PT) is a clinical professional responsible for conducting comprehensive reviews of medication care plans. This includes evaluating medical necessity, analyzing overall utilization, and identifying unusual usage patterns. The pharmacist may intervene and provide clinical guidance to patients and providers to support cost-effective medication use and promote high-quality patient outcomes.

Use your skills to make an impact
 

Required Qualifications:

• Bachelor’s degree or Doctor of Pharmacy (Pharm.D.) from an accredited college of pharmacy

• Active pharmacist license in the state of residence

• Eligibility to participate in federal prescription programs (e.g., Medicare/Medicaid)

• Self-directed with the ability to work effectively both independently and in a team environment

• Strong problem-solving skills and the ability to foster collaborative solutions

• High attention to detail with a strong work ethic focused on accuracy and productivity

• Excellent verbal and written communication skills

• Proficiency with computer systems, including but not limited to:

  • Microsoft Office Suite (Word, Excel, Outlook)

  • Clinical decision support tools (e.g., Micromedex, Lexicomp)

  • Pharmacy benefit management (PBM) platforms

  • Electronic health records (EHRs)

• Passion for contributing to an organization focused on continuously improving the consumer experience

Preferred Qualifications:

• Experience in managed care pharmacy, particularly in utilization management review

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Interview Format: As part of our hiring process for this opportunity, we will be using an interviewing technology called HireVue to enhance our hiring and decision-making ability. HireVue allows us to quickly connect and gain valuable information from you pertaining to your relevant skills and experience at a time that is best for your schedule.

WAH Requirements:

To ensure Home or Hybrid Home/Office employees’ ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office employees must meet the following criteria:
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
Employees who live and work from Home in the state of California, Illinois, Montana, or South Dakota will be provided a bi-weekly payment for their internet expense.
Humana will provide Home or Hybrid Home/Office employees with telephone equipment appropriate to meet the business requirements for their position/job.
Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information.

SSN Statement:

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.

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

Scheduled Weekly Hours

1

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