Remote Utilization Management Pharmacist - Clinical Reviews

Humana Inc; Raleigh (NC); 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

Business travel

Job summary

Humana Inc. is seeking a Utilization Management Clinical Pharmacist 2 (VSP/PT) to perform medical necessity reviews and comprehensive medication reviews for pre-authorizations. This role requires independent determination of appropriate actions in varied assignments.

The position emphasizes cost-effective utilization, quality patient outcomes, and adherence to guidelines, with remote work options and occasional travel to Humana offices for training or meetings.

Qualifications

• Bachelor's degree or equivalent is required.
• Less than 5 years of technical experience preferred.

Responsibilities

• Performs medical necessity and comprehensive medication reviews for pre-authorizations.
• Analyzes medication care plans and overall utilization.
• Intervenes and advises patients and providers to promote cost-effective utilization and quality patient outcomes.
• Follows established guidelines and procedures.

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 reviews for pre-authorizations. This role requires independent determination of appropriate actions in varied assignments.

The position emphasizes cost-effective utilization, quality patient outcomes, and adherence to guidelines, with remote work options and occasional travel to Humana offices for training or meetings.