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Humana RX Clinical Programs Lead, ADE/DUR in Troy, Michigan

Description

The RX Clinical Programs Lead develops strategies to align and integrate pharmacy and medical interventions with program goals of adverse drug events (ADEs) prevention or reduction and improving overall health outcomes. The Rx Clinical Programs Lead develops interventions/campaigns aimed at reducing and/or preventing ADEs prior to/at point of prescribing, at point of dispensing, and post dispensing. Reviews federal and/or state regulations for drug utilization requirements (DUR) and develops clinical and business strategies to meet the requirements. Assimilates literature, competitive intelligence, program outcomes, and analysis to contribute to the design and testing of new strategies and clinical pilots to improve appropriate use. Exercises independent judgment and decision making on complex issues regarding job duties and related tasks, works under minimal supervision, and analyzes variable factors to determine the best course of action.

Responsibilities

  • Develops clinical and business strategies designed to improve clinical quality, health outcomes, and make recommendations.

  • Drives the implementation of the program initiatives/campaigns.

  • Responsible for determining, clarifying and prioritizing scope of work commitments, deliverables and defining measurable success criteria to monitor progress toward goals.

  • Collaborates with analytics and/or research functions to project how initiatives will impact clinical quality/outcomes and cost of care.

  • Drives the creation of tools for effective monitoring of program and develops mitigation plans in effort to drive program success.

  • Collaborates with multidisciplinary teams and key stakeholders across enterprise to develop relationships; defines business, communication, and IT requirements and integration strategies for program implementation.

  • Ensures that the ADE and/or DUR program meets requirements for regulatory measures and accrediting bodies.

  • Prepares and provides presentations and/or communication materials on the program for internal/external stakeholders and leadership.

  • Responsible for program engagement and collaboration with vendor(s) and ensures effective working relationship(s) resulting in achievement of overall goals and performance metrics.

  • Responsible for financial management of the program budget including but not limited to: projecting budget needs, monitoring program initiatives relative to monthly spending and projections, and developing contingency plans if gaps are identified.

Required Qualifications:

  • Pharmacy Degree from an accredited School of Pharmacy

  • Clear and active Pharmacist license in the state(s) in which you are required to practice

  • 8+ years of clinical experience in managed care or pharmacy related field, or equivalent

  • 2+ years in project management or leadership experience

  • Proficiencies in Microsoft Office applications (especially Word, Excel, and PowerPoint)

Preferred Qualifications:

  • Prior experience in leading or managing clinical program initiatives that deliver improved health outcomes through improved medication useBoard Certified Pharmacist (e.g., BCACP, BCGP, BCPS, BCOP, BCPP)Accredited Pharmacy Practice Residency

  • MHA, MBA, and/or demonstrated business background

Scheduled Weekly Hours

40

About Us

Mission: At Humana, our cultural foundation is aligned to helping members achieve their best health by delivering personalized, simplified, whole-person healthcare experiences. Recognizing healthcare needs continue to evolve for each person, for each family and for each community, Humana continuously creates innovative solutions and resources that help people live their healthiest lives on their terms –when and where they need it. Our employees are at the heart of making this happen and that’s why we are dedicated to building an organization of dynamic talent whose experience and passion center on putting the customer first.

Equal Opportunity Employer

It is our policy to recruit, hire, train, and promote people without regard to race, color, religion, sex, national origin, age, sexual orientation, gender identity or expression, disability, or veteran status, except where age, sex, or physical status is a bona fide occupational qualification. View the EEO is the Law poster.

If you are an individual with a disability and require a reasonable accommodation to complete any part of the application process, or are limited in the ability or unable to access or use this online application process and need an alternative method for applying, you may contact mailboxtasrecruit@humana.com for assistance.

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Humana will never ask, nor require a candidate provide money for work equipment and network access during the application process. If you become aware of any instances where you as a candidate are asked to provide information and do not believe it is a legitimate request from Humana or affiliate, please contact mailboxtasrecruit@humana.com to validate the request.

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