Utilization Management Clinical Pharmacist

Become a part of our caring community and help us put health first

The Staff Utilization Management Pharmacist is a clinical expert responsible for conducting medical necessity and comprehensive medication reviews for prescriptions requiring prior authorization. This role involves evaluating complex clinical scenarios and applying evidence-based criteria to ensure appropriate medication use. The pharmacist addresses moderately complex to complex issues that require critical thinking and in-depth analysis of variable factors.

Earn a $5,000 hiring bonus!
Bonus is paid after 180 days of employment; you must be employed until that date to be eligible to receive the payment.

Location: Remote – United States

• 8-hour shifts, Monday through Friday, between 10:30 AM and 11:00 PM EST OR

• 10-hour shifts, Tuesday through Friday, between 10:30 AM and 11:00 PM EST

• Required to work every 5th Saturday

• Required to work 1 company holiday per calendar year

The Staff Utilization Management Pharmacist is a clinical professional responsible for conducting comprehensive reviews of medication care plans. This includes evaluating medical necessity, analyzing overall utilization, and identifying unusual usage patterns. The pharmacist may intervene and provide clinical guidance to patients and providers to support cost-effective medication use and promote high-quality patient outcomes.

• Bachelor’s degree or Doctor of Pharmacy (Pharm.
  
  D.) from an accredited college of pharmacy

• Active pharmacist license in the state of residence

• Eligibility to participate in federal prescription programs (e.g., Medicare/Medicaid)

• Self-directed with the ability to work effectively both independently and in a team environment

• Strong problem-solving skills and the ability to foster collaborative solutions

• High attention to detail with a strong work ethic focused on accuracy and productivity

• Excellent verbal and written communication skills

• Proficiency with computer systems, including but not limited to:

• Microsoft Office Suite (Word, Excel, Outlook)

• Clinical decision support tools (e.g., Micromedex, Lexicomp)

• Pharmacy benefit management (PBM) platforms

• Electronic health records (EHRs)

• Passion for contributing to an organization focused on continuously improving the consumer experience

• Experience in managed care pharmacy, particularly in utilization management review

Interview Format: As part of our hiring process for this opportunity, we will be using an interviewing technology called Hire Vue to enhance our hiring and decision-making ability. Hire Vue allows us to quickly connect and gain valuable information from you pertaining to your relevant skills and experience at a time that is best for your schedule.

To ensure Home or Hybrid Home/Office employees’ ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office employees must meet the following criteria:

At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is recommended; wireless, wired cable or DSL connection is suggested

Satellite, cellular and microwave connection can be used only if approved by leadership

Employees who live and work from Home in the state of California, Illinois, Montana, or South Dakota will be provided a bi-weekly payment for their internet expense.

Humana will provide Home or Hybrid Home/Office employees with telephone equipment appropriate to meet the business requirements for their position/job.

Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information.

SSN Statement:

Humana values personal identity protection. Please be aware that applicants may be asked to provide their Social Security Number, if it is not already on file. When required, an email will be sent from  with instructions on how to add the information into your official application on Humana’s secure website.

Travel:
While this is a remote position, occasional travel to Humana's offices for training or meetings may be required.

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The compensation range below reflects…