Medicare-Medicaid Pharmacy Director

Humana; United States; Remote; USD 126,000 - 174,000; Full time

Job summary

Join a leading health insurance provider as a Clinical Pharmacist Lead, focusing on improving healthcare outcomes through strategic pharmacy management. This remote position requires a licensed pharmacist in Michigan with substantial experience in managed care. Oversee programs that mitigate costs and enhance service quality, while collaborating with multidisciplinary teams to meet regulatory compliance.

Benefits

Medical, dental, and vision benefits

401(k) retirement savings plan

Paid time off and holidays

Short-term and long-term disability

Life insurance

Qualifications

• Must hold a PharmD and be licensed in Michigan.
• Over 10 years pharmacy experience required.
• Excellent communication and project management skills essential.

Responsibilities

• Develops corporate communications shared with senior leadership.
• Manages Humana Michigan FIDE-SNP health plan relationship.
• Consults across teams and manages projects collaboratively.

Skills

Communication

Project Management

Trend Analysis

Education

Bachelor’s degree in Pharmacy or Doctor of Pharmacy (PharmD)

Tools

Microsoft Word

Microsoft Excel

Microsoft PowerPoint

Job description

Become a part of our caring community and help us put health first
The Clinical Pharmacist Lead monitors drug development pipeline, and medical literature, while providing clinical support for internal stakeholders. Utilizes broad understanding of managed care and PBM knowledge to develop, and/or implement strategies and programs to mitigate cost trend and improve health outcomes. The Clinical Pharmacist Lead works on problems of diverse scope and complexity ranging from moderate to substantial.

The Pharmacy Director, internally known as a Clinical Pharmacy Lead, plans, directs, and monitors all financial, operational, professional, and clinical activities for the purposes of pharmacy program development for our Fully Integrated Dual Eligible Special Needs Plan (FIDE-SNP) Michigan Medicare - Medicaid health plan. The individual leverages a broad understanding of managed care and pharmacy benefit management (PBM) to develop and implement strategies and programs that drive trends and improve health outcomes. They ensure the pharmacy department provides optimal pharmaceutical services that meet all legal, accreditation, and certification requirements. This position will coordinate day-to-day pharmacy operations directly with the plan Chief Executive Officer and Chief Medical Officer.

POSITION RESPONSIBILITIES:

• Keeps current with State and Federal regulations regarding the practice of Pharmacy and implements changes as necessary to maintain compliance supporting both the business and public relations strategies.
• Develops corporate communications to be shared with senior leadership.
• Supports trend management by conducting analysis of drug spend, utilization, and/or approval scenarios.
• Advises executives to develop functional strategies (often segment specific) on matters of significance.
• Exercises independent judgment and decision making on complex issues regarding job duties and related tasks.
• Works under minimal supervision, using independent judgment requiring analysis of variable factors and determining the best course of action.
• Facilitates and consults across teams and managing projects working collaboratively and communicating with staff in different positions and all levels of management positions
• Manages the Humana Michigan FIDE-SNP health plan relationship with our internal PBM, Humana Pharmacy Solutions ensuring compliance with programmatic requirements, such as claims processing, prior authorization, formulary management and clinical programming
• Represents Humana at all Pharmacy Medicaid meetings including those with the Michigan Department of Health and Human Services (MDHHS)

Use your skills to make an impact

Required Qualifications

• Bachelor’s degree in Pharmacy or Doctor of Pharmacy (PharmD)
• Michigan-licensed pharmacist residing or willing to relocate to Michigan

• Minimum of ten plus years of Pharmacy Experience with at least three years’ experience in managed care and/or PBM operations

• Ability to travel 10% of time

• Successful track record in facilitating and consulting across teams and managing projects
• Thrives in a fast paced, multi-project work environment while still ensuring attention to detail
• Excellent communication skills, both oral and written
• Proficiency in Microsoft Word, Excel, & PowerPoint
• Expertise in working collaboratively and communicating with staff in different positions and all levels of management positions

Preferred Qualifications

• Master's degree in public health, Business Administration or a related field
• Board Certified Specialty Pharmacist
• Experience with Microsoft Access & Microsoft Project
• Experience with data analytics

Additional Information:

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.

Work at home 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 required; 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 Alert:

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 [e-mail] 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

40

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 based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc.$126,300 - $173,700 per yearThis job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance.

Description of Benefits

Humana, Inc. and its affiliated subsidiaries (collectively, “Humana”) offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.
About us
Humana Inc. (NYSE: HUM) is committed to putting health first – for our teammates, our customers and our company. Through our Humana insurance services and CenterWell healthcare services, we make it easier for the millions of people we serve to achieve their best health – delivering the care and service they need, when they need it. These efforts are leading to a better quality of life for people with Medicare, Medicaid, families, individuals, military service personnel, and communities at large.

Equal Opportunity Employer

It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status. It is also the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and VEVRAA, to employ and to advance in employment individuals with disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment.