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Humana HPS Clinical Drug Policy Management - Senior Operations Professional in Springfield, Missouri

Description

The Senior Clinical Drug Policy Management Professional provides clinical and operational leadership for the creation and maintenance of clinical tools which help facilitate clinical medication review decision. The Senior Clinical Drug Policy Management Professional work assignments involve moderately complex to complex issues where the analysis of situations or data requires an in-depth evaluation of variable factors.

Responsibilities

  • Provides operational leadership for the creation and maintenance of clinical tools which help facilitate clinical medication review decision making

  • Work responsibilities are varied and frequently require interpretation and independent determination of the appropriate courses of action

  • Ensures accuracy of clinical tools builds across multiple systems (PA Hub, CPS, IRx) by assisting the expansion of quality programs within the Medicaid space

  • Collaborates with healthcare professionals, pharmacists, and other business functions to operationalize processes

  • Performs analysis and reporting to ensure optimal operational flow

  • Develops key performance indicators and plans to improve overall Medicaid processes and efficiency

  • Creates Clinical Drug Policy Management process and training documentation

  • Provides excellent service to our customers and stakeholders

  • Begins to influence department's strategy. Makes decisions on moderately complex to complex issues regarding technical approach for project components, and work is performed without direction. Exercises considerable latitude in determining objectives and approaches to assignments.

Required Qualifications

  • Bachelor's degree

  • 2 - 5 years of experience of leading successful continuous improvements projects using various process tools like Value Stream Mapping (VSM), Pareto analysis, fish bone diagrams etc.

  • Comprehensive experience in analysis with the ability to graphically represent data

  • Experience in change management techniques and project implementation

  • Extensive knowledge of process re-engineering techniques

  • Comprehensive knowledge of all Microsoft Office applications, including Excel, Word, PowerPoint, Project and Visio

Preferred Qualifications

  • Strong consultative skills and relationship building skills

  • Must be passionate about contributing to an organization focused on continuously improving consumer experiences

  • Lean Certification, Six Sigma Black Belt or higher designation

Additional Information

Scheduled Weekly Hours

40

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