Remote Utilization Management Pharmacist | Clinical Impact

Humana Inc; Salem (OR); Remote; 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 and accident coverage

Job summary

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

The role emphasizes independent interpretation, optimizing utilization, and ensuring high-quality patient outcomes while aligning with Humana's strategic objectives. The position supports remote work with occasional travel to Humana offices for training or meetings.

Qualifications

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

Responsibilities

• Performs medical necessity reviews and comprehensive medication reviews for prescriptions needing pre-authorization.
• Analyzes medication care plans and utilization, identifying unusual usage patterns.
• Intervenes and advises patients and providers to promote cost-effective utilization and quality outcomes.
• Follows department, segment, and organizational strategy and operating objectives; makes decisions with minimal direction when appropriate.

Skills

Clinical Pharmacist

Education

Bachelor's degree or equivalent

Job description

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

The role emphasizes independent interpretation, optimizing utilization, and ensuring high-quality patient outcomes while aligning with Humana's strategic objectives. The position supports remote work with occasional travel to Humana offices for training or meetings.