• Own Medicaid Drug- and Market-Level Forecasting End-to-End • Design, build, and maintain forecasts for drug-level utilization (script counts, days supply, cost, mix) and market-level utilization for each Medicaid state Humana supports • Produce forecasts at the cadence required by the business (e.g., monthly refresh, ad-hoc scenarios, launch projections, annual planning) • Maintain a forecasting framework that is transparent, reproducible, and version-controlled • Explicitly handle state-by-state differences in Data availability, member cohort composition, benefit design, and other factors • Select and apply the right method for the problem, including classical time series and machine learning models • Quantify and communicate uncertainty rather than presenting point estimates alone • Diagnose and clearly explain the drivers of variance to executive stakeholders • Partner with various stakeholders to ensure forecasts reflect the best available business intelligence and operational reality • Leverage AI agents and modern coding tools to accelerate model development in Databricks using Python, PySpark, and/or SQL

• Participates in all aspects of the medication-use system while delivering comprehensive and personalized pharmaceutical care to patients in their designated areas. • Assumes leadership and accountability for specific clinical pharmacy areas. • Demonstrates advanced skills and expertise, and obtains advanced certification in their practice area if available. • Manages patient drug therapy in accordance with applicable clinical practice standards. • Assures the appropriateness of all provider medication orders in maintaining a high level of patient care and safety. • Maintains advanced knowledge of medication use, disease states, and regulations applicable to their area of practice. • Serves as the primary resource for drug information and education. • Provides in-depth patient counseling when required. • Supports the training of new employees and participates in the creation and maintenance of training materials. • Assumes local and system responsibility and ownership for assigned tasks. • Follows and assists with the development of policies and procedures. • Demonstrates superior customer service, effective communication, decision-making, and organization to ensure efficient job performance and success. • Ensures adequate supplies are available for continuous patient care. • Triages and escalates any questions or issues outside the scope of practice as needed. • Uses appropriate systems for processing of patient information. • Ensures quality assurance is maintained according to departmental and legal requirements. • Precepts pharmacy students and/or pharmacy residents as assigned. • Provides peer coaching and constructive feedback to other colleagues in a professional and productive manner. • Successfully leads local and system implementation of various system initiatives. • Serves as a system expert and site lead in specialized clinical pharmacy functions.

• Analyze medication utilization data to identify trends in polypharmacy, adherence, and high-cost drug use. • Develop and implement strategies to reduce unnecessary polypharmacy, improve adherence, and optimize cost-effective therapies. • Collaborate with care teams to design interventions that lower total cost of care while maintaining or improving outcomes. • Monitor and report the impact of medication management strategies on clinical and financial results. • Provide actionable insights to support value-based contracts and performance improvement initiatives. • Participate in initiatives to improve population health metrics related to medication use. • Conduct comprehensive medication reviews for patients with chronic conditions (e.g., diabetes, hypertension, obesity, heart failure, asthma, depression). • Identify and resolve drug therapy problems; optimize regimens; track and report outcomes and safety metrics. • Advise providers on best practices, guidelines, and new therapies. • Educate patients on medication use, side effects, and adherence. • Document all interventions, recommendations, and patient education in the electronic health record (EHR).

Role Description - Processes prior authorization requests received by phone, fax, or electronically, and utilizes various computer resources, existing criteria, and medication guidelines to perform clinical research to support prior authorization reviews. - Proactively completes prior authorization approvals and denials that are due to expire and maintains complete, timely, and accurate documentation. - Reviews potential prior authorization denial language to ensure NCQA requirements are met. - Follows prior authorization workflow, policies, and procedures during the course of the workday. - Answers a potentially high volume of prior authorization inquiry calls from provider's offices, pharmacies, members, and internal partners, and uses various computer resources to communicate prior authorization status or decisions. - Maintains a balance of productivity, quality, and timeliness of work. - Participates in training and continuing education as required. - Participates in team/departmental meetings as required. - Excellent attendance is a must. - Successful pharmacy technicians will be proficient in drug name and diagnosis pronunciation, recognizing medical terminology, and navigating multiple computer resources to document conversations and prior authorization decisions. - Successful pharmacy technicians will possess good written and verbal communication skills. - Hours of operation for Aetna Pharmacy Prior Authorization are between 5:00am to 7:00pm (may vary by time zone). Pharmacy Technicians work 8 hour shifts that may fall in between these hours of operations. Overnight shifts may also be available, but not guaranteed. Work schedule is approximate, and hours/days may change based on company needs. All full-time employees are required to complete forty (40) hours per week as scheduled, including on weekends and holidays. Part time positions are not available. Position requires the ability to work extended hours when necessary. - Rotating weekend schedule may be required. - Candidate must have their own home internet access with minimum speed of 100mbps download (internet should be hard wired with Ethernet cord). - Candidate must have a secure workspace/office in their home. - Candidate must have high level skill with working with a PC (ex. using mouse and keyboard, accessing and navigating through multiple systems and screens). Qualifications - National Pharmacy Technician certification and state licensure or applicable state Pharmacy Technician license, current and in good standing, are required and must be maintained. - Between 0-5+ years of Pharmacy Technician experience. - Ability to multi-task and prioritize work. - Ability to adjust based on business or department needs. - Good organization skills. Preferred Qualifications - Retail or Hospital experience. - Prior Authorization processing experience. - Claims processing experience. - Managed Care, Medicare, and/or Medicaid experience. - AS400 experience. - Proficiency in using computerized resources and software applications. - Proficiency with Microsoft applications (Excel, Word, and Outlook). - Knowledge in pharmacy practices, procedures, and ability to read and understand clinical information. - Working knowledge of drug dosage forms, drug strength, generic and brand name equivalent. Education - High School diploma, G.E.D. Anticipated Weekly Hours - 40 Time Type - Full time Pay Range The typical pay range for this role is: $18.50 - $35.29. This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above. Benefits - This full‑time position is eligible for a comprehensive benefits package designed to support the physical, emotional, and financial well‑being of colleagues and their families. - The benefits for this position include medical, dental, and vision coverage, paid time off, retirement savings options, wellness programs, and other resources, based on eligibility. - Additional details about available benefits are provided during the application process and on Benefits Moments.