Medicaid Pharmacy Lead

Profile

Description

The Medicaid Oklahoma Pharmacy Director 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 Medicaid Pharmacy Director works on problems of diverse scope and complexity ranging from moderate to substantial.

Responsibilities

Location: work at home Oklahoma only

Humana's Oklahoma Medicaid Pharmacy Director will be responsible for the operations of all pharmacy-related activities for our Oklahoma Medicaid contract. They will leverage a broad understanding of managed care and Pharmacy Benefit Management (PBM) to develop and implement strategies and programs to drive trend and improve health outcomes. The Pharmacy

Director will monitor the drug development pipeline and medical literature, while providing clinical support for internal and external stakeholders.

Essential Functions and Responsibilities:


Oversee prior authorization requirements and criteria to ensure compliance with programmatic requirements
Engage leadership with Humana Pharmacy Solutions (HPS) programs and lead the pull-through of HPS initiatives aligned with Medicaid
Manage the Humana Oklahoma Medicaid plan relationship with our corporate pharmacy claims team
Monitor programs and procedures to ensure compliance with state and federal regulations; implement and maintain processes to assure adherence
Identify applicable and effective local and national pharmacy trends by conducting analysis of drug spend, utilization, and approval scenarios
Recommend quality and resource management solutions to reduce waste and unnecessary treatment
Initiate and implement programs to identify pharmacy and prescription fraud, waste, and abuse
Create methods to promote the improvement of enrollee outcomes by encouraging the use of appropriate pharmaceuticals
Maintain and review the pharmaceutical formulary
Develop and manage qualified Medicaid pharmacy staff


Role Essentials


Must have an active Pharmacy License in Oklahoma
Minimum three (3) years of experience in managed care and/or PBM experience
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 individually different positions and all levels of management positions


Role Desirables


Medicaid experience
Advanced knowledge of pharmacy programs, policies, and procedures across Medicaid managed care plan operations
Master's degree in Public Health, Business, or related field


Additional Information

Humana is an organization with careers that change lives-including yours. As an innovator in the fast-paced industry of healthcare, we offer our associates careers that challenge, support and inspire them to use their passion for helping others and to lead their best lives. If you're ready to help people achieve lifelong well-being, and be a part of an organization that is growing and poised to make an impact on the future of healthcare, Humana has the right opportunity for you.

Scheduled Weekly Hours

40

Company info

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