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The Clinical Drug Evaluation and Policy Strategies Senior Clinical Pharmacist Program & Automation Strategy Expert supports government program strategies and evaluates drug polices for clinically appropriate automation opportunities. In addition, the Senior Clinical Pharmacist Program & Automation Strategy Expert will provide government program and clinical automation support for internal stakeholders. This position will utilize broad understanding of managed care and PBM knowledge to develop, and/or implement strategies and programs and will be charged to appropriately balance how we mitigate utilization management administrative costs while maintaining or decreasing drug spend & trend, decrease member access to care barriers, and improve health outcomes while ensuring clinical and safety parameters are prioritized for the members we serve. The Senior Clinical Pharmacist Program & Automation Strategy Expert work assignments involve moderately complex to complex issues where the analysis of situations or data requires an in-depth evaluation of variable factors.

The Clinical Drug Evaluation and Policy Strategies Senior Clinical Pharmacist Program & Automation Strategy Expert develops and/or maintains clinical strategies (to include automation) related to Drug Denial Lines (DL), Drug Auto Authorization Extension (AAE), Drug Medically Accepted Indication (MAI), Fast Pass (FP), Prior Authorization Hub (PAHub), and Non-Formulary Guide (NFG). This individual influences the department’s strategy for optimizing the utilization management process in balance with mitigating drug utilization trend.

Participate in Humana’s formulary and Pharmacy and Therapeutics processes

Acts Strategically: Has vision, anticipates future consequences and trends accurately; has broad knowledge and perspective; creates competitive and breakthrough strategies and plans.

Builds Trust: You honor your word by doing what you say you are going to do.

Drives for Excellence: You are a continuous learner who encourages others to learn. By constantly upgrading your own work, you achieve results and outperform the competition.

Innovates - Introduces or develops new ideas and processes which improve performance or productivity.

Implementation/Execution: You are good at organizing and managing multiple priorities and/or projects by using appropriate methodologies and tools.

Problem Solving: You are a problem solver with the ability to encourage others in collaborative problem solving. Acting as both a broker and consultant regarding resources, you engage others in problem solving without taking over.

Use your skills to make an impact
 

Required Qualifications

• Pharmacy degree from an accredited school of pharmacy

• Must have an active Pharmacist license with the Board of Pharmacy in the appropriate state

• Complete clinical reviews assessing for appropriate automation opportunities and recommend drug utilization tools to mitigate Humana’s cost and trend while improving our member’s access to care, health, and costs

• Serve as a clinical automation and program strategy subject matter expert and provide clinical automation strategy support across Humana

• Conducts analysis on administrative costs and utilization trends to evaluate and inform strategies

• Collaborates on research projects and develops proposals for research projects

• Develops corporate communications to be shared with senior leadership

• Supports administrative costs and drug trend management by conducting analysis of drug spend, utilization, and/or approval scenarios

• Makes decisions on moderately complex to complex issues regarding technical approach for project components, and work is performed without direction

• Exercises considerable latitude in determining objectives and approaches to assignments

• Clinical experience in managed care or other pharmacy related field

• Less than 10% travel requirement including visit(s) to home office in Louisville, KY

Preferred Qualifications

• BPS Board Certification (any BPS certification)

• Pharmacoeconomics and Health Outcomes training

• Pharmacy practice residency or similar pharmacy practice experience

• Knowledge of Medicare and Medicaid as it relates to pharmacy

• Six Sigma and/or Project Management Professional certification