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