Staff Utilization Management Clinical Pharmacist (VSP/PT)
About The Position
The Utilization Management Clinical Pharmacist 2 (VSP/PT) completes medical necessity and comprehensive medication reviews for prescriptions requiring pre-authorization. Work assignments are varied and frequently require interpretation and independent determination of appropriate courses of action. This is a remote U.S. role with variable staffing hours of 24–40 per week. Training is scheduled from 10:00 a.m. to 6:30 p.m. ET; afterward, a mid-to-later shift will be assigned based on business needs. Some weekend coverage may be required, and mandatory overtime is expected during peak season. The role requires a dedicated, interruption-free workspace to protect member PHI/HIPAA information, along with home internet service meeting Humana's stated speed requirements. Humana provides telephone equipment appropriate for the job. Occasional travel to Humana offices for training or meetings may be required.
Requirements
- 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, such as Medicare or Medicaid.
- Ability to work effectively independently and in a team environment.
- Strong problem-solving skills and ability to foster collaborative solutions.
- High attention to detail and a strong work ethic focused on accuracy and productivity.
- Excellent verbal and written communication skills.
- Proficiency with computer systems, including Microsoft Office Suite (Word, Excel, Outlook), clinical decision support tools (such as Micromedex and Lexicomp), pharmacy benefit management platforms, and electronic health records.
- Passion for contributing to an organization focused on continuously improving the consumer experience.
- Home internet service meeting the stated minimum requirements: 25 Mbps download and 10 Mbps upload; a dedicated workspace without ongoing interruptions is required to protect member PHI/HIPAA information.
- Occasional travel to Humana offices for training or meetings may be required.
Nice To Haves
- Experience in managed care pharmacy, particularly in utilization management review.
Responsibilities
- Complete medical necessity reviews for prescriptions requiring pre-authorization.
- Complete comprehensive medication reviews for prescriptions requiring pre-authorization.
- Independently interpret cases and determine appropriate courses of action.
- Provide some weekend coverage as required and work mandatory overtime during peak season.
Benefits
- Paid time off
- 401(k) retirement savings plan
- Employee assistance program
- Business travel and accident benefits
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What This Job Offers
Job Type
Part-time
Education Level
Ph.D. or professional degree
