Remote Utilization Management Clinical Pharmacist

Humana Inc; City of Albany (NY); On-site; USD 104,000 - 143,000; Full time

Job summary

Humana Inc. is seeking an Utilization Management Clinical Pharmacist 2 (VSP/PT) to perform medical necessity reviews and comprehensive medication analysis for pre-authorized prescriptions.

The role involves independent interpretation of care plans, identification of unusual usage, and advising patients and providers to optimize outcomes. The position is remote with occasional travel to Humana offices for training or meetings.

Qualifications

• Typically requires Bachelor's degree or equivalent and less than 5 years of technical experience.
• Performs medical necessity reviews and comprehensive medication reviews for prescriptions needing pre-authorization.
• Interprets guidelines and operates with minimal supervision while following established procedures.

Responsibilities

• Completes medical necessity and comprehensive medication reviews for pre-authorized prescriptions.
• Intervenes and advises patients and providers to promote cost-effective utilization and quality outcomes.
• Makes decisions on own work methods within established guidelines.

Skills

Clinical pharmacist

Medical necessity review

Medication reviews

Patient counseling

Interpreting guidelines

Education

Bachelor's degree

Job description

Humana Inc. is seeking an Utilization Management Clinical Pharmacist 2 (VSP/PT) to perform medical necessity reviews and comprehensive medication analysis for pre-authorized prescriptions.

The role involves independent interpretation of care plans, identification of unusual usage, and advising patients and providers to optimize outcomes. The position is remote with occasional travel to Humana offices for training or meetings.