Associate Director – Formulary Operations Management

Job not on LinkedIn

🔥 1 hour ago

🇺🇸 United States – Remote

💵 $126.3k - $173.7k / year

⏰ Full Time

🟠 Senior

⚙️ Operations

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Humana

WebsiteLinkedInAll Job Openings

10,000+ employees

Founded 1961

🏥 Healthcare

🛡️ Insurance

⚕️ Healthcare Insurance

Healthcare • Insurance • Healthcare Insurance

Humana is a healthcare company dedicated to making a positive impact on the health of individuals, communities, and the healthcare system as a whole. With a focus on putting health first, Humana serves a diverse range of populations, including seniors and the military, providing Medicare Advantage HMO, PPO, and PFFS plans. Humana is committed to fostering a culture of belonging and mutual respect, offering competitive and flexible benefits to ensure the financial security of its employees and their families. The company prides itself on creating an inclusive workplace where everyone has the opportunity to succeed.

📋 Description

• Lead formulary development and maintenance activities across applicable products and lines of business • Oversee operational implementation of formulary changes in coordination with clinical, configuration, product, and operational teams • Support development and execution of utilization management programs, including prior authorization, step therapy, quantity limits, and coverage • Evaluate formulary performance and operational impacts through data analysis and reporting • Ensure compliance with state, federal, and client formulary requirements • Develop and maintain policies, procedures, and supporting documentation for formulary operations • Partner with stakeholders on formulary submissions, audits, regulatory reviews, and implementations • Lead strategic projects related to formulary optimization, operational excellence, and process improvement • Lead, develop, and support a high-performing team through expectation-setting, coaching, career development, and accountability • Manage formulary operations workflow, quality, capacity, training, reporting, issue resolution, and people leadership • Work during standard Eastern Time business hours

🎯 Requirements

• Bachelor's degree • 6 or more years of healthcare, pharmacy benefit management (PBM), managed care, health plan, formulary, pharmacy operations, or related experience • 2 or more years of leadership, management, project leadership, or people leadership experience • Experience leading cross-functional initiatives involving multiple stakeholders • Strong analytical and problem-solving skills • Strong organizational and project management skills • Ability to manage multiple priorities and deadlines in a fast-paced environment • Excellent verbal and written communication skills, including executive-level communication • Comprehensive knowledge of Microsoft Office applications, including Excel, PowerPoint, Word, and Teams • Demonstrated ability to influence and drive organizational outcomes • Strong problem solving, critical thinking and analytical skills • Passion for contributing to an organization focused on continuously improving consumer experiences • Self-provided home internet with minimum download speed of 25 Mbps and upload speed of 10 Mbps • Work from a dedicated space without ongoing interruptions to protect member PHI/HIPAA information

🏖️ Benefits

• Bonus incentive plan based on company and/or individual performance • Medical benefits • Dental benefits • Vision benefits • 401(k) retirement savings plan • Paid time off • Company holidays • Personal holidays • Paid parental leave • Paid caregiver leave • Short-term disability • Long-term disability • Life insurance • Dedicated work-from-home space • Remote work arrangement • Occasional travel to Humana offices for training or meetings

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