Humana Clinical Pharmacy Advisor Lead, Trend in Boston, Massachusetts
The Clinical Pharmacy Advisor lead, overseeing Humana Pharmacy and Medical Trend, is a dynamic role within Humana. We are seeking a positive and proactive individual to contribute to a high performing team that helps translate the clinical into financial. The goals is to help ensure Humana profitability while improving our member's health and costs. This role functions in a highly collaborative environment across multiple departments to drive results.
This individual will lead medical and pharmacy trend review and the identification of trend bender strategies.
Responsibilities include the following:
Utilize broad understanding of managed care to develop strategies to mitigate Humana's medical and pharmacy cost and trend while improving our member's health and costs.
Developing concrete trend mitigation opportunities from abstract information and concepts
Own the medical and pharmacy trend monitoring process including month over month, quarter over quarter and year over year medical trend review.
Lead trend management by conducting and analyzing drug spend, utilization and market share.
Lead the analysis and generation of insights related to medical and pharmacy trend to inform future trend-mitigation strategy.
Produce top quality presentations and reports to share with senior leadership such as trend updates, and market event notifications.
Continuously monitor relevant publicly available news/developments in the pharmaceutical sector, performing any ad hoc analyses and generating insights.
Collaborate with a multidisciplinary team in order to evaluate potential initiatives.
Collaborate with pharmacists, business professionals and actuaries in a team environment.
Present confidently to senior leadership on key metrics and trend.
Support clinical research integration activities with internal research department.
Lead multidisciplinary meetings, embracing the keys of Essential Facilitation, to drive to alignment and results.
Role Requirements and Competencies
Experience drawing conclusions and generating action from abstract asks
Confident in rapidly reprioritizing and adapting to business needs
Understands managed care and is capable of generating broad insights into the business
Accountable to financial goals and a history of delivering business results
Ability to influence others to achieve goals and meet deadlines
Strong critical thinking skills
Ability to see connections across large organizations
Works well independently and within a team setting to achieve goals and meet deadlines
Demonstrates initiative and the ability to multi-task and prioritize assignments
Ability to lead initiatives or projects
Ability to assimilate, analyze, draw conclusions, and make recommendations from complex data
Very strong presentation skills
Able to produce clear, concise documentation
Positive and proactive
Additional Job Description
Clinical degree (e.g. Pharm. D.)
Three years clinical experience in managed care or pharmacy related field
Experience in managing the strategic planning cycle for a large organization with cross-functional engagement and prioritization
Experience executing complex strategic and operational initiatives
Problem-solving and project management skills
Previous experience in trend analysis
Excellent oral and written communication skills, previous experience presenting and interacting with senior leadership
Flexible, dynamic personality with a demonstrated ability to lead and influence others without authority while contributing individually
Previous experience in medical claims analysis
Working knowledge of MS excel, MS PowerPoint required
Board Certified Pharmacotherapy Specialist (BCPS)
MBA, pharmacoeconomics or health outcomes training
Six Sigma, Lean (or other quality program) background
Scheduled Weekly Hours
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