Remote Utilization Management Clinical Pharmacist

Humana Inc; Columbia (SC); 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

Job summary

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

The role involves interpreting guidelines, optimizing utilization, and advising patients and providers while following Humana's standards and procedures. Remote work is possible with occasional travel to Humana offices for training or meetings.

Qualifications

• Clinical pharmacist responsible for medical necessity and comprehensive medication reviews for pre-authorization prescriptions.
• Interprets guidelines to determine appropriate courses of action with minimal direction.

Responsibilities

• Complete medication reviews and medical necessity determinations for pre-authorizations.
• Intervene with patients and providers to promote cost-effective utilization and quality outcomes.
• Follow established guidelines and understand organizational strategy.

Skills

Clinical pharmacy

Medical necessity review

Pre-authorization

Education

Bachelor's degree or equivalent

Job description

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

The role involves interpreting guidelines, optimizing utilization, and advising patients and providers while following Humana's standards and procedures. Remote work is possible with occasional travel to Humana offices for training or meetings.