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Humana Clinical Pharmacy Lead (NC) - Group Medicare in Lancaster, South Carolina


This role supports the Humana Group Medicare (EGWP) plans for all pharmacy activities. The Clinical Pharmacy Lead will be responsible for providing consultative Account Management Pharmacy Support for key assigned clients. They will leverage a broad understanding of managed care, Pharmacy Benefits and Clinical Products to implement strategies to drive trend and improve health outcomes. The Clinical Pharmacy Lead will deliver quarterly/annual account reviews of pharmacy financial information, utilization metrics and quality performance. This is a Work At Home (WAH) position, supporting North Carolina, that requires travel to meet with assigned clients.


  • Primary focus of position is the pharmacy subject matter expert, supporting internal partners (Humana Pharmacy Solutions, Group Medicare Sales and Account Management team) and external partners (Employer Groups).

  • Providing full service account management for the Humana Senior Products Medicare division for all pharmacy-related needs

  • Providing financial and utilization analysis related to pharmacy trends and collaborating with Group Medicare leadership on managing and understanding drivers of pharmacy utilization and spend.

  • Providing expertise for annual pharmacy benefit planning and readiness activities

  • Work with internal stakeholders to define appropriate messaging, strategy, and data analysis for internal Group Medicare team and external clients

  • Provide expertise and support to internal Group Medicare team and external clients related to pharmacy quality measures

  • Support meaningful adoption of pharmacy /clinical products with in Group Medicare; influencing clients to use our products and/or optimize the performance of the product

  • Identify clinical needs and pharmacy product opportunities within Group Medicare and communicate them to Clinical Product Organization (CPO) Leadership team

  • Collaborate with product leaders to provide input to pharmacy product development based on client feedback

Required Qualifications

  • PharmD degree or Bachelor of Science degree in Pharmacy from a college accredited by the American Council on Pharmaceutical Education (ACPE)

  • Active Pharmacy license, and in good standing

  • Minimum three (3) years of PBM experience

  • Minimum three (3) years of experience in Group Medicare or Commercial Account Management

  • Experience writing /reviewing RFP responses and performing formulary comparisons based on disruption analysis

  • Knowledge of pharmacy practice and the cost drivers of pharmacy

  • Familiarity with Pharmacy utilization, spend and trend financials

  • Successful track record in facilitating and consulting across teams and managing projects

  • Experience managing multiple priorities, multiple accounts /projects

  • Ability to work independently under general instructions and with a team

  • Ability to develop cross functional relationships across multiple operational departments

  • Excellent communication skills, both oral and written

  • Strong analytical skills to interpret utilization metrics and deliver meaningful message to clients

  • Ability to draft, prepare and deliver presentations

  • Proficiency in Microsoft Applications including Word, Excel, & Power Point

  • Approximately 30% overnight travel required

Preferred Qualifications

  • Advanced Microsoft Excel skills

  • Proficiency with Microsoft Access & Microsoft Project

  • Experience with pharmacy benefits and health benefits management

Additional Information

Scheduled Weekly Hours


About Us

Mission: At Humana, our cultural foundation is aligned to helping members achieve their best health by delivering personalized, simplified, whole-person healthcare experiences. Recognizing healthcare needs continue to evolve for each person, for each family and for each community, Humana continuously creates innovative solutions and resources that help people live their healthiest lives on their terms –when and where they need it. Our employees are at the heart of making this happen and that’s why we are dedicated to building an organization of dynamic talent whose experience and passion center on putting the customer first.

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