Staff Utilization Management Clinical Pharmacist – VSP/PT

This is a fully remote position, open to applicants in United States.

📋 Description

• Conduct medical necessity evaluations and thorough medication reviews for prescriptions that need pre-authorization.

• Execute comprehensive analyses of medication care plans.

• Assess overall medication utilization.

• Recognize abnormal usage trends.

• Engage with and provide guidance to patients and healthcare providers.

• Advocate for cost-effective medication use and improved patient outcomes.

• Interpret guidelines and autonomously determine suitable courses of action.

• Make decisions regarding work processes with minimal supervision.

• Occasionally travel to Humana offices for training sessions or meetings as necessary.

⛳️ Requirements

• Bachelor's degree or equivalent qualification.

• Less than 5 years of relevant technical experience.

• Proficiency in completing medical necessity assessments and thorough medication reviews.

• Ability to analyze medication care plans and overall utilization effectively.

• Skill in identifying unusual medication usage patterns.

• Capability to interpret established guidelines and procedures accurately.

• Competence in making independent decisions in uncertain situations.

• Minimum internet download speed of 25 Mbps and upload speed of 10 Mbps.

• A dedicated workspace free from ongoing interruptions to safeguard member PHI/HIPAA information.

• Willingness to travel occasionally to Humana offices for training or meetings.

🏝️ Benefits

• Paid time off.

• 401(k) retirement savings plan.

• Employee assistance program.

• Business travel and accident benefits.

• Self-provided internet service for remote employees.

• Remote work from a designated space.

• Comprehensive well-being benefits for the whole person.