Remote Clinical Utilization Management Pharmacist

Humana Inc; Phoenix (AZ); On-site; USD 104,000 - 143,000; Full time

Benefits offered by this job

Remote work from home

Travel for training

Job summary

Humana, Inc. is seeking a Utilization Management Clinical Pharmacist 2 (VSP/PT) to perform medical necessity determinations and comprehensive medication reviews for pre-authorizations.

The role requires clinical judgment and the ability to interpret guidelines with minimal supervision. The successful candidate will assess medication care plans, identify utilization patterns, and collaborate with patients and providers to promote cost-effective, high-quality outcomes.

Qualifications

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

Responsibilities

• Completes medical necessity and comprehensive medication reviews for prescriptions requiring preauthorization.
• Intervenes and advises patients and providers to promote cost-effective utilization and quality outcomes.
• Interprets guidelines and makes independent decisions with minimal direction.

Education

Bachelor's degree or equivalent

Job description

Humana, Inc. is seeking a Utilization Management Clinical Pharmacist 2 (VSP/PT) to perform medical necessity determinations and comprehensive medication reviews for pre-authorizations.

The role requires clinical judgment and the ability to interpret guidelines with minimal supervision. The successful candidate will assess medication care plans, identify utilization patterns, and collaborate with patients and providers to promote cost-effective, high-quality outcomes.