Humana · 1 day ago
Staff Utilization Management Clinical Pharmacist
United States
Full-time
Remote
Lead/Staff
$104K/yr - $143K/yrHumana is committed to putting health first and is seeking a Staff Utilization Management Clinical Pharmacist. This role involves conducting medical necessity reviews and providing clinical guidance to ensure appropriate medication use and promote high-quality patient outcomes.
Health CareHealth InsuranceInsuranceVenture Capital
Responsibilities
Conducting medical necessity and comprehensive medication reviews for prescriptions requiring prior authorization
Evaluating complex clinical scenarios and applying evidence-based criteria to ensure appropriate medication use
Addressing moderately complex to complex issues that require critical thinking and in-depth analysis of variable factors
Conducting comprehensive reviews of medication care plans
Evaluating medical necessity, analyzing overall utilization, and identifying unusual usage patterns
Intervening and providing clinical guidance to patients and providers to support cost-effective medication use and promote high-quality patient outcomes
Qualification
Required
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
Preferred
Experience in managed care pharmacy, particularly in utilization management review
Benefits
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
Company
Humana
Humana is a health insurance provider for individuals, families, and businesses.
Founded in 1964
10001+ employees
H1B Sponsorship
Humana has a track record of offering H1B sponsorships. Please note that this does not
guarantee sponsorship for this specific role. Below presents additional info for your
reference. (Data Powered by US Department of Labor)
Distribution of Different Job Fields Receiving Sponsorship
Represents job field similar to this job
Trends of Total Sponsorships
2025 (282)
2024 (246)
2023 (284)
2022 (274)
2021 (212)
2020 (84)
Funding
Current Stage
Public CompanyTotal Funding
$13.07B2025-05-30Post Ipo Debt· $5B
2025-03-03Post Ipo Debt· $1.25B
2024-03-11Post Ipo Debt· $2.25B
Leadership Team
Jim Rechtin
CEO and President
Colin Drylie
Senior Vice President, Experience Transformation
Recent News
2026-01-09
2026-01-07
2026-01-06
Company data provided by crunchbase