Remote Medicaid Pharmacy Director — Strategy and Savings

Become a part of our caring community and help us put health first The Clinical Pharmacist Lead 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 Clinical Pharmacist Lead works on problems of diverse scope and complexity ranging from moderate to substantial. The Pharmacy Director, internally known as a Clinical Pharmacy Lead, plans, directs, and monitors all financial, operational, professional, and clinical activities for the purposes of pharmacy program development for our Medicaid and Fully Integrated Dual Eligible Special Needs Plan (FIDE-SNP) Virginia health plan. The individual leverages a broad understanding of managed care and pharmacy benefit management (PBM) to develop and implement strategies and programs that mitigate cost trends and improve health outcomes. They ensure the pharmacy department provides optimal pharmaceutical services that meet all legal, accreditation, and certification requirements. This position will coordinate day-to-day pharmacy operations directly with the plan Chief Executive Officer and Chief Medical Officer. POSITION RESPONSIBILITIES: Keeps current with State and Federal regulations regarding the practice of Pharmacy and implements changes as necessary to maintain compliance supporting both the business and public relations strategies.Develops corporate communications to be shared with senior leadership.Supports trend management by conducting analysis of drug spend, utilization, and/or approval scenarios.Advises executives to develop functional strategies (often segment specific) on matters of significance.Exercises independent judgment and decision making on complex issues regarding job duties and related tasks.Works under minimal supervision, using independent judgment requiring analysis of variable factors and determining the best course of action.Facilitates and consults across teams and managing projects working collaboratively and communicating with staff in different positions and all levels of management positionsManages the Virginia health plan relationship with our internal PBM, Humana Pharmacy Solutions ensuring compliance with programmatic requirements, such as claims processing, prior authorization, formulary management and clinical programmingRepresents Humana at all Pharmacy Medicaid meetings including those with the Virginia Department of Medical Assistance Services (DMAS)Develops, executes and manages National Medicaid Pharmacy programs as needed.Use your skills to make an impact Required Qualifications Bachelor’s degree in Pharmacy or Doctor of Pharmacy (PharmD)Must reside and have an active Pharmacist license with the Board of Pharmacy in Virginia.Minimum of ten plus years of Pharmacy Experience with at least three years’ experience in managed care and/or PBM operationsAbility to travel 10% of timeSuccessful track record in facilitating and consulting across teams and managing projectsThrives in a fast paced, multi-project work environment while still ensuring attention to detailExcellent communication skills, both oral and writtenProficiency in Microsoft Word, Excel, & PowerPointExpertise in working collaboratively and communicating with staff in different positions and all levels of management positionPreference to candidates who currently live in or in the vicinity of Richmond, VA. Preferred Qualifications Bachelor’s degree (or higher) in public health, Business Administration or a related fieldBoard Certified Specialty PharmacistExperience with Microsoft Access & Microsoft ProjectExperience with data analyticsAdditional Information: As part of our hiring process for this opportunity, we will be using an interviewing technology called HireVue to enhance our hiring and decision-making ability. HireVue 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. Work at home requirements: 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 required; 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 Alert: 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 [email protected] 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. Scheduled Weekly Hours 40 Pay Range The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc. $138,900 - $191,000 per year This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance. Description of Benefits Humana, Inc. and its affiliated subsidiaries (collectively, “Humana”) offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities. Application Deadline: 04-02-2026 About us Humana Inc. (NYSE: HUM) is committed to putting health first – for our teammates, our customers and our company. Through our Humana insurance services and CenterWell healthcare services, we make it easier for the millions of people we serve to achieve their best health – delivering the care and service they need, when they need it. These efforts are leading to a better quality of life for people with Medicare, Medicaid, families, individuals, military service personnel, and communities at large.Equal Opportunity Employer It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status. It is also the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and VEVRAA, to employ and to advance in employment individuals with disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment. Humana complies with all applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, sex, sexual orientation, gender identity or religion. We also provide free language interpreter services. See our https://www.humana.com/legal/accessibility-resources?source=Humana_Website.#J-18808-Ljbffr