Humana Staff Utilization Management Pharmacist/ Staff RX Clinical Programs /LT (Part Time Contract Position - Pharmacist - Remote, Puerto Rico in San Juan, Puerto Rico
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.
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. Intervenes and advises patients and providers to promote cost effective utilization and quality patient outcomes, as needed. Begins to influence department's strategy. 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.
Pharm D or Pharmacy Bachelor's degree from an accredited college of pharmacy
Must have an active license and register with the Board of Pharmacy in Puerto Rico
1+ year experience in Prior Authorization processes in Manage Care or Health Insurance (Health plan) setting
3+ years of experience in a community pharmacy practice environment
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
Excellent communication skills
Proficient with computers
Remote requirements: Must have the ability to provide a high speed DSL or cable modem for a home office (Satellite and Wireless Internet service is NOT allowed for this role). A minimum standard speed for optimal performance of 10x1 (10mbs download x 1mbs upload) is required. A dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information
COVID Vaccination : We will require full COVID vaccination for this job as we are a healthcare company committed to putting health and safety first for our members, patients, associates and the communities we serve. If progressed to offer, you will be required to provide proof of full vaccination or documentation for a medical or religious exemption consideration where allowed by law. Requests for these exemptions should be submitted at least 2 week prior to your scheduled first day of work.
Excellent communication skills, both oral and written, English (Intermediate) and Spanish (Advance). Candidate selected will not be communicating in English with Members.
Ability to use web-based technology, computer software/systems and the necessary productivity tools to accomplish individual and team objectives
Ability to work with multiple priorities
Schedule: Monday to Friday. Part Time position (no more than 30 hrs. weekly)
Training: 1 month. Part in the office and then at home
Limited Term position. Limited Term (LT) associates with Humana may work any number of hours, depending on the business needs, for a limited time (usually 1 to 180 days). Benefits: Paid Time Off (PTO), Eligibility to participate in Humana's Partnership Savings Plan - Associates will be automatically enrolled in the 401K (accounts vest automatically on day one). Business Travel Accident Insurance. Associate Well-being Programs (WOW, EAP, Great Deals, Helping Hands, Giving Together, etc.). Reduced or Free Parking (depending on the geographic location) *Puerto Rico associates are not eligible to earn PTO but they will earn Vacation and Sick Time.
Work Location (Address): Remote, Puerto Rico ONLY
UNIQUENESS OF THIS JOB: At some point may have to work On-call rotation during weekends, possible one weekend a month and 2 Holiday weekends in the year. This will be additional pay to this Pharmacist.
Scheduled Weekly Hours
- Humana Jobs