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The Director of Clinical Pharmacy Drug Evaluation and Policy Strategies is responsible for leading the development, implementation, and evaluation of pharmacy policies and drug evaluation processes within the organization. This position specifically oversees drug class reviews and evaluations, the development of clinical policy strategies, the oversight and accreditation of the Pharmacy and Therapeutics (P&T) Committee, and the strategies for utilization management automation programs. The Director will collaborate with leaders across the Humana enterprise and engage extensively with HPS executive leaders, as well as represent Humana in interactions with drug manufacturers, providers, and other external stakeholders.The Director of Clinical Pharmacy Drug Evaluation and Policy Strategies requires a comprehensive understanding of clinical evidence, utilization management trends, and managed care to develop clinical strategies that ensure the right drug is delivered for the right outcome at the right time and cost. This position is crucial for upholding and enhancing our strong foundation of clinical integrity. The Director must possess an in-depth understanding of how organizational capabilities interrelate across various functions and segments. This role presents an exciting opportunity for a visionary leader to influence pharmacy practice and enhance patient care outcomes through innovative drug evaluation and policy strategies.
Responsibilities
- Leads leaders who are responsible for developing the next generation of clinical talent for the pharmacy organization
- Oversees Humana’s Pharmacy and Therapeutics processes, including clinical drug reviews, drug policy development, and drug utilization management strategies.
- Leads a team of clinical pharmacists that serve as subject matter experts in assigned therapeutic areas
- Leads a team of clinical pharmacists that are responsible for translating clinical policies into automation program strategies
- Promotes evidence-based medicine and total cost of care models in our pharmacy processes and formulary decisions
- Works with appropriate business partners to ensure accurate and timely implementation of drug strategy decisions
- Ensures that compliance standards set by regulators, URAC, and NCQA are defined and documented in Humana’s policies and procedures, and processes are followed and audited
- Participates in Humana committees as appropriate
- Promotes a continuous process improvement mindset, with a focus on comprehensive process documentation and quality
- Advocates for Humana’s clinical drug strategies in internal and external forums
Use your skills to make an impact
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
- Board Certified Pharmacist
- 8+ years of clinical experience in managed care or equivalent experience
- 5+ years of formulary and drug policy development experience or equivalent experience
- 5+ years experience in effectively leading direct reports and cross-functional teams
- Strong track record of driving solutions that achieved clinical and financial outcomes
- Exceptional cross-functional collaboration, relationship management, influencing, and interpersonal skills
- Impeccable oral and written communication skills, as well as the polish, poise, and executive presence to effectively interact with and present to external partners and executive and senior-level stakeholders
- Very disciplined; has the ability to manage competing priorities and operate effectively within a large and complex organizational structure
- Ability to engage, educate, influence and guide matrixed teams at all levels on the concepts, opportunities and strategy of managing traditional and specialty medications
- Ability to influence and build relationships with people across all levels and organizations internally and externally
Preferred Qualifications
- MBA, pharmacoeconomics or health outcomes training
- Experience in finance and/or business-related pharmacy practice
- Ability to travel approximately 10%
Additional Information
Interview Format:
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 Humana@myworkday.com with instructions on how to add the information into your official application on Humana’s secure website.
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Scheduled Weekly Hours
40Pay 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.$168,000 - $231,000 per yearThis 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: 04-17-2025
About us
About CenterWell Pharmacy: CenterWell Pharmacy provides convenient, safe, reliable pharmacy services and is committed to excellence and quality. Through our home delivery and over-the-counter fulfillment services, specialty, and retail pharmacy locations, we provide customers simple, integrated solutions every time. We care for patients with chronic and complex illnesses, as well as offer personalized clinical and educational services to improve health outcomes and drive superior medication adherence.About CenterWell, a Humana company: CenterWell creates experiences that put patients at the center. As the nation’s largest provider of senior-focused primary care, one of the largest providers of home health services, and fourth largest pharmacy benefit manager, CenterWell is focused on whole-person health by addressing the physical, emotional and social wellness of our patients. As part of Humana Inc. (NYSE: HUM), CenterWell offers stability, industry-leading benefits, and opportunities to grow yourself and your career. We proudly employ more than 30,000 clinicians who are committed to putting health first – for our teammates, patients, communities and company. By providing flexible scheduling options, clinical certifications, leadership development programs and career coaching, we allow employees to invest in their personal and professional well-being, all from day one.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 veteran status. It is also the policy of Humana to take affirmative action to employ and to advance in employment, all persons regardless of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, 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.
