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Humana Clinical Pharmacy Lead - Remote, Ohio in Cincinnati, Ohio


Humana Healthy Horizons in Ohio (Medicaid) is seeking a Clinical Pharmacy Lead who will monitor drug development pipeline, and medical literature, while providing support for internal and external stakeholders. Utilizes broad understanding of managed care and Pharmacy Benefit Management (PBM) knowledge to develop, and/or implement strategies and programs to mitigate cost trend and improve health outcomes. The Medicaid Pharmacy Lead works on problems of diverse scope and complexity ranging from moderate to substantial.


Role Responsibilities:

  • Oversees contract responsibilities related to pharmacy benefits.

  • Coordinates, collaborates and strategizes with the Single Pharmacy Benefit Manager (SPBM)

  • Coordinates with Ohio Department of Medicaid (ODM) to provide input in the review of new drugs to market, changes to ODM's Preferred Drug List, and ODM's/SPBM's prior authorization criteria for pharmacy benefits.

  • Oversees the MCO's medication therapy management programs.

  • Monitoring, managing, and coordinating the care of the plan's members as it relates to utilization of prescription drugs (e.g., Coordinated Services Program, use of antipsychotics in children).

  • Collaborates closely with Humana's health services team, leadership and the health equity director to reduce health disparities, improve health outcomes and increase health equity.

  • Participates in the Pharmacy and Therapeutics Committee, the Drug Utilization Review Committee, the Drug Utilization Review Board, and any other committee or board as requested by ODM.

Required Qualifications

  • An active unrestricted Pharmacy License in the state of Ohio.

  • Must reside in the state of Ohio.

  • Experience in state and federally funded health care programs.

  • Three - five (3 -5) years of experience as a practicing pharmacist.

  • Proficiency in Microsoft Word, Excel, & PowerPoint.

  • Successful track record in facilitating and consulting across teams and managing projects.

  • Thrives in a fast paced, multi-project work environment while still ensuring attention to detail.

  • Excellent communication skills, both oral and written.

  • Proficiency in Microsoft Word, Excel, & PowerPoint.

  • Expertise in working collaboratively and communicating with individuals in various roles and all levels of leadership.

  • Must have a room in your home designated as a home office; away from high traffic areas where confidential information may be secured.

  • 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.

  • For this job, associates are required to be fully COVID vaccinated or undergo weekly COVID testing and wear a face covering while at work. The weekly testing will need to be done through an approved Humana vendor, and unvaccinated associates should follow all social distancing and masking protocols if they are required to come into a Humana facility or work outside of their home. 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 Commit to weekly testing, following all CDC protocols, OR Provide documentation for a medical or religious exemption consideration. This policy will not supersede state or local laws. Requests for these exemptions should be submitted at least 2 weeks prior to your scheduled first day of work.

Preferred Qualifications

  • Master's degree in Public Health, Business, or related field.

  • Medicaid experience.

  • Advanced knowledge of pharmacy programs, policies, and procedures across Medicaid managed care plan operations.

  • Pharmacy benefit management experience.

  • Experience in managed care.

Additional Information

  • Workstyle: Hybrid Home - The associate will work in Humana Healthy Horizons office in Dublin, OH occasionally for collaboration and other face to face needs typically 1 - 2 days per week. In office days will be determined by leadership.

  • Travel: Up to 10%.

Interview Format

As part of our hiring process, we will be using an exciting interviewing technology provided by Modern Hire, a third-party vendor. This technology provides our team of recruiters and hiring managers an enhanced method for decision-making.

If you are selected to move forward from your application prescreen, you will receive correspondence inviting you to participate in a pre-recorded Voice Interview and/or an SMS Text Messaging interview. If participating in a pre-recorded interview, you will respond to a set of interview questions via your phone. You should anticipate this interview to take approximately 10-15 minutes.

If participating in a SMS Text interview, you will be asked a series of questions to which you will be using your cell phone or computer to answer the questions provided. Expect this type of interview to last anywhere from 5-10 minutes. Your recorded interview(s) via text and/or pre-recorded voice will be reviewed and you will subsequently be informed if you will be moving forward to next round of interviews.

Scheduled Weekly Hours