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Humana
Staff Utilization Management Clinical Pharmacist (VSP/PT)
Humana Honolulu, HI, USA
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. The hours will vary between 24-40 hours per week. The s hift for training will be 10:00AM-630PM ET. After training, a shift of either 11:00AM-730PM ET, 12:00PM-830PM, or 1:00PM-930PM will be assigned based on business need. Some weekend coverage may be required. Mandatory overtime during peak season. Job Description: The Staff...

Jan 24, 2026
Humana
Risk Management Professional
Humana Honolulu, HI, USA
Become a part of our caring community and help us put health first The Risk Management Professional 2 identifies and analyzes potential sources of loss to minimize risk. The Risk Management Professional 2 work assignments are varied and frequently require interpretation and independent determination of the appropriate courses of action. Makes decisions regarding own work methods, occasionally in ambiguous situations, and requires minimal direction and receives guidance where needed. Follows established guidelines and procedures. As a Risk Management Professional 2 - HCPR Compliance, you will work with HCPR Operations to ensure operational processes are complaint with appropriate regulations and report data that accurately reflects operations. In this role you will: In this role you will: Develop data universe generation guidelines (DUGG) for audit universes by interpreting protocols/guidance and reconciling it to processes/system logic Produce monthly...

Jan 11, 2026
Humana
Lead - Medicaid and Group Medicare Project Management
Humana Honolulu, HI, USA
Become a part of our caring community and help us put health first The Project Management Lead manages all aspects of a project, from start to finish, so that it is completed on time and within budget. The Project Management Lead works on problems of diverse scope and complexity ranging from moderate to substantial. The Project Management Lead designs, communicates, and implements an operational plan for completing the project; monitors progress and performance against the project plan; takes action to resolve operational problems and minimize delays. Identifies, develops, and gathers the resources to complete the project. Prepares designs and work specifications; develops project schedules, budgets and forecasts; and selecting materials, equipment, project staff, and external contractors. Communicates with other operational areas in the organization to secure specialized resources and contributions for the project. Conducts meetings and prepare reports to communicate the...

Jan 10, 2026
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