Remote Utilization Management Clinical Pharmacist

Humana Inc; Trenton (NJ); On-site; USD 104,000 - 143,000; Full time

Job summary

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

The role involves analyzing medication care plans, utilization, and advising patients and providers to promote cost-effective utilization and optimal outcomes. This is a remote position with occasional travel to Humana offices for training.

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 pre-authorization.
• Intervenes and advises patients and providers to promote cost effective utilization and quality patient outcomes.
• Understands department, segment, and organizational strategy and operating objectives, including their linkages to related areas.
• Makes decisions regarding own work methods, occasionally in ambiguous situations, and requires 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 prescriptions requiring pre-authorization.

The role involves analyzing medication care plans, utilization, and advising patients and providers to promote cost-effective utilization and optimal outcomes. This is a remote position with occasional travel to Humana offices for training.