Staff Utilization Management Pharmacist

Humana; Juneau (AK); Remote; USD 94,000 - 131,000; Full time

Job summary

Join a leading healthcare company as a Staff Utilization Management Pharmacist, where you will conduct comprehensive medication reviews and ensure quality patient outcomes. This remote position requires a Pharm.D and an active pharmacy license, with responsibilities including advising patients and providers on medication utilization. Enjoy competitive pay and benefits while making a significant impact on healthcare quality.

Benefits

Medical, dental, and vision benefits

401(k) retirement savings plan

Paid time off and holidays

Short-term and long-term disability

Life insurance

Qualifications

• Active license with the Board of Pharmacy in the state of residence.
• Ability to participate in Federal prescription programs.
• Managed care experience preferred.

Responsibilities

• Complete medical necessity and medication reviews for prescriptions.
• Advise patients and providers to promote cost-effective utilization.
• Analyze medication care plans and identify unusual usage patterns.

Skills

Problem-solving

Communication

Self-directed

Education

Bachelor's degree/Pharm.D

Pharmacy degree from an accredited college

Job description

Become a part of our caring community and help us put health first

Job Description Summary

The Staff Utilization Management Pharmacist is a clinical pharmacist who completes medical necessity and comprehensive medication reviews for prescriptions requiring pre-authorization. The Staff Utilization Management Pharmacist work assignments involve moderately complex to complex issues where the analysis of situations or data requires an in-depth evaluation of variable factors.

Schedule :

• Able to work 8 hour shifts Monday thru Friday between 10:30am and11:00pm EST OR 10 hour shifts Tuesday thru Friday between 10:30am and 11:00pm EST.

• Every 5th Saturday will be required

• 1 company holiday will be required in 2025

Location: Remote United States

Job Description

The Staff Utilization Management Pharmacist completes a review that includes a full analysis of the medication care plan, investigation of overall utilization, and identification of unusual usage patterns. The Pharmacist intervenes and advises patients and providers to promote cost effective utilization and quality patient outcomes as needed.

Use your skills to make an impact

Required Qualifications

• Bachelor's degree/Pharm.D

• Must have an active license with the Board of Pharmacy in the state of residence

• Pharmacy degree from an accredited college of pharmacy

• Ability to participate in Federal prescription programs (Medicare/Medicaid reviews)

• Self-directed, but also able to work well in a group

• Ability to solve problems and encourage others in collaborative problem solving

• Work ethic that is focused, accurate, and highly productive

• Strong communication skills

• Proficient with computers -- various systems: add examples

• Must be passionate about contributing to an organization focused on continuously improving consumer experiences

Preferred Qualifications

Managed care experience - specifically Utilization management review

Additional Information:

Interview Format : As part of our hiring process for this opportunity, we will be using an interviewing technology called HireVue to enhance our hiring and decision-making ability. HireVue allows us to quickly connect and gain valuable information from you pertaining to your relevant skills and experience at a time that is best for your schedule.

WAH Requirements:

To ensure Home or Hybrid Home/Office employees’ ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office employees must meet the following criteria:

At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is recommended; wireless, wired cable or DSL connection is suggested

Satellite, cellular and microwave connection can be used only if approved by leadership

Employees who live and work from Home in the state of California, Illinois, Montana, or South Dakota will be provided a bi-weekly payment for their internet expense.

Humana will provide Home or Hybrid Home/Office employees with telephone equipment appropriate to meet the business requirements for their position/job.

Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information.

SSN Statement:

Humana values personal identity protection. Please be aware that applicants may be asked to provide their Social Security Number, if it is not already on file. When required, an email will be sent from [e-mail] with instructions on how to add the information into your official application on Humana’s secure website.

Travel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be required.

Scheduled Weekly Hours

40

Pay Range

The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc.

$94,900 - $130,500 per year

This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance.

Description of Benefits

Humana, Inc. and its affiliated subsidiaries (collectively, “Humana”) offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.

Application Deadline: 05-22-2025

About us

Humana Inc. (NYSE: HUM) is committed to putting health first – for our teammates, our customers and our company. Through our Humana insurance services and CenterWell healthcare services, we make it easier for the millions of people we serve to achieve their best health – delivering the care and service they need, when they need it. These efforts are leading to a better quality of life for people with Medicare, Medicaid, families, individuals, military service personnel, and communities at large.

Equal Opportunity Employer

It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status. It is also the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and VEVRAA, to employ and to advance in employment individuals with disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment.

Humana complies with all applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, sex, sexual orientation, gender identity or religion. We also provide free language interpreter services. See our https://www.humana.com/legal/accessibility-resources?source=Humana_Website.