Medicaid Drug Strategy Lead

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

The Clinical Pharmacy Lead requires a broad understanding of pharmacy, managed care, PBM, market and regulatory insights to develop, and/or implement drug strategies to mitigate cost trend and improve health outcomes. The Clinical Pharmacy Lead work assignments involve moderately complex to complex issues where the analysis of situations or data requires an in-depth evaluation of variable factors.

The Clinical Pharmacy Lead uses clinical and financial data driven methods to develop and influence drug strategies for the Medicaid lines of business.

• Utilizes broad understanding of pharmacy, managed care, PBM, market and regulatory insights to support the development of Medicaid formulary and medical drug strategies to mitigate Humana’s costs and trend while improving our member’s health outcomes and costs.
• Help facilitate and provide transparency to informed formulary and medical drug decisions made consistent with our formulary guiding principles and Medicaid state requirements.
• Translates information from multiple sources to clearly communicate a compelling clinical, data-driven message to executive-level audiences on our drug strategies.
• Works across multiple departments to support formulary and medical drug strategy development and decisions. 
• Works with appropriate business partners to ensure accurate and timely implementation and maintenance of Humana driven Medicaid drug strategy decisions.
• Leverages market trends and competitive intel insights to support the development of strategies.
• Makes decisions on moderately complex to complex issues regarding technical approach for project components, and work is performed without direction. Exercises considerable latitude in determining objectives and approaches to assignments.

• Key Competencies
  • Acts Strategically: Has vision, anticipates future consequences and trends accurately; has broad knowledge and perspective; creates competitive and breakthrough strategies and plans.
  • Builds Trust: You honor your word by doing what you say you are going to do.
  • Drives for Excellence: You are a continuous learner who encourages others to learn. By constantly upgrading your own work, you achieve results and outperform the competition.
  • Innovates - Introduces or develops new ideas and processes which improve performance or productivity.
  • Implementation/Execution: You are good at organizing and managing multiple priorities and/or projects by using appropriate methodologies and tools.
  • Problem Solving: You are a problem solver with the ability to encourage others in collaborative problem solving. Acting as both a broker and consultant regarding resources, you engage others in problem solving without taking over.

Use your skills to make an impact
 

Required Qualifications:

• Pharmacy Degree from an accredited School of Pharmacy
• 3+ years of clinical experience in managed care or other pharmacy related field
• Experience in analysis and problem-solving
• Excellent oral and written communication skills, previous experience presenting and interacting with senior leadership
• Flexible, dynamic personality who works well in a team environment and is also an individual contributor
• Experience building out new processes and developing infrastructure for new processes.
• Ability to prioritize, organizes, and executes effective time management
• Ability to assimilate, analyze, draw conclusions, and make recommendations from complex data
• Ability to work in either a team or an individual capacity to achieve goals and meet deadlines
• Successful track record in facilitating and consulting across teams and managing projects
• Proficient in Microsoft Office products: Powerpoint, Excel, Word

Preferred Qualifications:

• BPS Board Certification (any BPS certification)
• Pharmacy practice residency or similar pharmacy practice experience
• Knowledge of Medicaid as it relates to pharmacy
• Experience in Formulary development
• Experience in finance and/or business-related pharmacy practice

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.

 

$126,300 - $173,700 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: 06-01-2025

About us
 

About CenterWell Pharmacy: CenterWell Pharmacy provides convenient, safe, reliable pharmacy services and is committed to excellence and quality. Through our home delivery and over-the-counter fulfillment services, specialty, and retail pharmacy locations, we provide customers simple, integrated solutions every time. We care for patients with chronic and complex illnesses, as well as offer personalized clinical and educational services to improve health outcomes and drive superior medication adherence.

About CenterWell, a Humana company: CenterWell creates experiences that put patients at the center. As the nation’s largest provider of senior-focused primary care, one of the largest providers of home health services, and fourth largest pharmacy benefit manager, CenterWell is focused on whole-person health by addressing the physical, emotional and social wellness of our patients. As part of Humana Inc. (NYSE: HUM), CenterWell offers stability, industry-leading benefits, and opportunities to grow yourself and your career. We proudly employ more than 30,000 clinicians who are committed to putting health first – for our teammates, patients, communities and company. By providing flexible scheduling options, clinical certifications, leadership development programs and career coaching, we allow employees to invest in their personal and professional well-being, all from day one.

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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.