Staff Utilization Management Clinical Pharmacist – VSP/PT

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

📋 Description

• Conduct comprehensive medication reviews and assess medical necessity for prescriptions that require pre-authorization.

• Analyze cases and make independent decisions on suitable actions.

• Engage in diverse tasks related to utilization management.

• Attend training sessions from 10:00 AM to 6:30 PM ET.

• Work mid-to-later shifts as needed by the business.

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

• Collaborate effectively with team members to enhance the consumer experience.

⛳️ Requirements

• Doctor of Pharmacy (Pharm.D.) degree from an accredited college of pharmacy.

• Active pharmacist license in the state of residence.

• Eligibility for participation in federal prescription programs (e.g., Medicare/Medicaid).

• Ability to work effectively both independently and within a team environment.

• Strong problem-solving abilities.

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

• Excellent verbal and written communication skills.

• Proficiency in Microsoft Office Suite (Word, Excel, Outlook).

• Proficiency in clinical decision support tools (e.g., Micromedex, Lexicomp).

• Familiarity with pharmacy benefit management (PBM) platforms.

• Experience with electronic health records (EHRs).

• Passion for continuously enhancing the consumer experience.

• A dedicated workspace that ensures protection of member PHI/HIPAA information.

• Home internet service with a minimum of 25 Mbps download and 10 Mbps upload speed.

• Ability to work flexible hours between 24–40 hours per week, including assigned mid-to-later shifts.

• Some weekend availability may be necessary.

• Willingness to work mandatory overtime during peak seasons.

🏝️ Benefits

• Paid time off.

• 401(k) retirement savings plan.

• Employee assistance program.

• Business travel and accident benefits.

• Internet expense reimbursement for employees working from home in California, Illinois, Montana, or South Dakota.

• Humana-provided telephone equipment suitable for business needs.