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Humana Clinical Pharmacy Advisor Lead, Trend in Aberdeen, South Dakota

Description

The Clinical Pharmacy Advisor lead, overseeing Humana Pharmacy and Medical Trend, is a dynamic role within Humana. We are seeking a positive and proactive individual to contribute to a high performing team that helps translate the clinical into financial. The goals is to help ensure Humana profitability while improving our member's health and costs. This role functions in a highly collaborative environment across multiple departments to drive results.

This individual will lead medical and pharmacy trend review and the identification of trend bender strategies.

Responsibilities

Responsibilities include the following:

  • Utilize broad understanding of managed care to develop strategies to mitigate Humana's medical and pharmacy cost and trend while improving our member's health and costs.

  • Developing concrete trend mitigation opportunities from abstract information and concepts

  • Own the medical and pharmacy trend monitoring process including month over month, quarter over quarter and year over year medical trend review.

  • Lead trend management by conducting and analyzing drug spend, utilization and market share.

  • Lead the analysis and generation of insights related to medical and pharmacy trend to inform future trend-mitigation strategy.

  • Produce top quality presentations and reports to share with senior leadership such as trend updates, and market event notifications.

  • Continuously monitor relevant publicly available news/developments in the pharmaceutical sector, performing any ad hoc analyses and generating insights.

  • Collaborate with a multidisciplinary team in order to evaluate potential initiatives.

  • Collaborate with pharmacists, business professionals and actuaries in a team environment.

  • Present confidently to senior leadership on key metrics and trend.

  • Support clinical research integration activities with internal research department.

  • Lead multidisciplinary meetings, embracing the keys of Essential Facilitation, to drive to alignment and results.

Role Requirements and Competencies

  • Experience drawing conclusions and generating action from abstract asks

  • Confident in rapidly reprioritizing and adapting to business needs

  • Understands managed care and is capable of generating broad insights into the business

  • Self-directed

  • Accountable to financial goals and a history of delivering business results

  • Ability to influence others to achieve goals and meet deadlines

  • Strong critical thinking skills

  • Ability to see connections across large organizations

  • Works well independently and within a team setting to achieve goals and meet deadlines

  • Demonstrates initiative and the ability to multi-task and prioritize assignments

  • Ability to lead initiatives or projects

  • Ability to assimilate, analyze, draw conclusions, and make recommendations from complex data

  • Very strong presentation skills

  • Able to produce clear, concise documentation

  • Positive and proactive

Additional Job Description

Required Qualifications

  • Clinical degree (e.g. Pharm. D.)

  • Three years clinical experience in managed care or pharmacy related field

  • Experience in managing the strategic planning cycle for a large organization with cross-functional engagement and prioritization

  • Experience executing complex strategic and operational initiatives

  • Problem-solving and project management skills

  • Previous experience in trend analysis

  • Excellent oral and written communication skills, previous experience presenting and interacting with senior leadership

  • Flexible, dynamic personality with a demonstrated ability to lead and influence others without authority while contributing individually

  • Previous experience in medical claims analysis

  • Working knowledge of MS excel, MS PowerPoint required

Preferred Qualifications

  • Board Certified Pharmacotherapy Specialist (BCPS)

  • MBA, pharmacoeconomics or health outcomes training

  • Six Sigma, Lean (or other quality program) background

Scheduled Weekly Hours

40

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