The Clinical Pharmacy Lead, Medicare Formulary Build manages and coordinates the formulary strategy activities associated with the annual Medicare formulary build process. In addition, the Clinical Pharmacy Lead, Medicare Formulary Build monitors drug development pipeline, and medical literature, while providing clinical support for internal stakeholders. Utilizes broad understanding of managed care and PBM knowledge to develop, and/or implement strategies and programs to mitigate cost trend and improve health outcomes. The Clinical Pharmacy Lead, Medicare Formulary Build work assignments involve moderately complex to complex issues where the analysis of situations or data requires an in-depth evaluation of variable factors.
- Facilitate and document strategic discussions regarding Medicare formularies
- Present Medicare formulary coverage recommendation to various internal stakeholders and levels of Humana leadership
- Participate in Humana’s formulary and Pharmacy and Therapeutics processes
- Complete clinical reviews, policy development and recommend drug coverage and potential drug utilization tools to mitigate Humana’s cost and trend while improving our member’s health and costs
- Serve as a clinical subject matter expert and provide clinical support across Humana
- Conducts analysis on drug utilization trends to evaluate and inform formulary strategies.
- Collaborates on research projects and develops proposals for research projects.
- Develops corporate communications to be shared with senior leadership.
- Supports trend management by conducting analysis of drug spend, utilization, and/or approval scenarios.
- 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.
- Degree of Doctor of Pharmacy
- Clinical experience in managed care
- Knowledge of Medicare as it relates to pharmacy
- Experience in analysis and problem-solving
- Excellent oral and written communication skills
- Flexible, dynamic personality who works well in a team environment and is also an individual contributor
- 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
- Board Certified Pharmacotherapy Specialist
- Pharmacoeconomics and Health Outcomes training
- Pharmacy practice residency or similar pharmacy practice experience
- Six Sigma and/or Project Management Professional certification
Scheduled Weekly Hours