- Job Reference: 287390679-2
- Date Posted: 19 May 2021
- Recruiter: Humana
- Location: Tulsa, Oklahoma
- Salary: On Application
- Sector: Healthcare & Medical
- Job Type: Permanent
Job Description
*Description* Job Description Summary 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