Remote Clinical Pharmacist – Utilization Management

Humana Inc; Boston (MA); On-site; USD 104,000 - 143,000; Full time

Benefits offered by this job

Paid time off

401(k) retirement savings plan

Employee assistance program

Business travel

Job summary

Humana Inc. is seeking an Utilization Management Clinical Pharmacist 2 (VSP/PT) to perform medical necessity reviews and comprehensive medication assessments for pre‑authorization requests.

The role requires independent judgment within established guidelines to support quality patient outcomes. You will analyze medication care plans, identify unusual utilization patterns, and advise patients and providers to promote cost‑effective care.

Qualifications

• Typically requires Bachelor's degree or equivalent and less than 5 years of technical experience.

Responsibilities

• Performs medical necessity reviews for prescriptions requiring pre-authorization.
• Completes comprehensive medication reviews and analyzes the medication care plan.
• Intervenes and advises patients and providers to promote cost‑effective utilization and quality outcomes.
• Follows established guidelines and procedures.

Education

Bachelor's degree or equivalent

Job description

Humana Inc. is seeking an Utilization Management Clinical Pharmacist 2 (VSP/PT) to perform medical necessity reviews and comprehensive medication assessments for pre‑authorization requests.

The role requires independent judgment within established guidelines to support quality patient outcomes. You will analyze medication care plans, identify unusual utilization patterns, and advise patients and providers to promote cost‑effective care.