Utilization Management Clinical Pharmacist; VSP​/PT

Become a part of our caring community and help us put health first

The Staff Utilization Management Pharmacist (VSP/PT) is a clinical expert responsible for conducting medical necessity and comprehensive medication reviews for prescriptions requiring prior authorization. This role involves evaluating complex clinical scenarios and applying evidence‑based criteria to ensure appropriate medication use. The pharmacist addresses moderately complex to complex issues that require critical thinking and in‑depth analysis of variable factors.

Location: Remote – United States

Schedule: This is a VSP (Variable Service Provider) role. Hours will vary between 24-40 hours per week.

Shift for training: 10:00 AM–6:30 PM ET.

Post‑training shift options: 11:00 AM–7:30 PM ET, 12:00 PM–8:30 PM, or 1:00 PM–9:30 PM, based on business need. Some weekend coverage and mandatory overtime during peak season may be required.

The Staff Utilization Management Pharmacist (VSP/PT) is a clinical professional responsible for conducting comprehensive reviews of medication care plans. This includes evaluating medical necessity, analyzing overall utilization, and identifying unusual usage patterns. The pharmacist may intervene and provide clinical guidance to patients and providers to support cost‑effective medication use and promote high‑quality patient outcomes.

Use your skills to make an impact

• 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 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 Microsoft Office Suite, clinical decision support tools (e.g., Micromedex, Lexicomp), pharmacy benefit management (PBM) platforms, and electronic health records (EHRs)
• Passion for contributing to an organization focused on continuously improving the consumer experience

• Experience in managed care pharmacy, particularly in utilization management review

As part of our hiring process for this opportunity, we will be using an interviewing technology called Hire Vue to enhance our hiring and decision‑making ability. Hire Vue allows us to quickly connect and gain valuable information from you regarding your relevant skills and experience at a time that fits your schedule.

For employees working from home or a hybrid home/office arrangement, the self‑provided internet service must meet the following criteria:

• At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps (wireless, wired or DSL connection recommended). Satellite, cellular and microwave connections may be used only if approved by leadership.
• Employees living and working from home in California, Illinois, Montana, or South Dakota will receive a bi‑weekly payment for their internet expense.

Humana will provide telephone equipment appropriate to meet the business requirements for the position.

Work from a dedicated space lacking ongoing interruptions to protect member PHI/HIPAA information.

Humana values personal identity protection. 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  with instructions on how to add the information into your official application on Humana’s secure website.

While this is a remote position, occasional travel to Humana’s offices for training or meetings may be required.

$104,000 – $143,000 per year (full time, 40 hours per week). The range may vary based on geographic location, experience, and qualifications.

Humana, Inc. offers benefits for limited‑term, variable‑schedule, and per‑diem associates designed to support whole‑person well‑being. Benefits…