Associate Director, Formulary Operations Management

Humana

1d•$126,300 - $173,700•Remote

About The Position

The Associate Director, Formulary Operations Management leads the development, implementation, maintenance, and governance of pharmacy formularies and utilization management strategies across lines of business. The role translates formulary strategy into operational execution, ensuring decisions are accurately implemented and aligned with regulatory requirements, business objectives, and member needs. The position partners with clinical, operational, regulatory, analytics, product, and other internal and external stakeholders to implement formulary strategies, oversee utilization management initiatives, support regulatory submissions, and ensure accurate implementation of coverage decisions. The Associate Director is accountable for formulary operations workflows, quality, capacity, training, reporting, issue resolution, and people leadership. The role works standard Eastern Time business hours and is remote, with occasional travel to Humana offices for training or meetings potentially required.

Requirements

Bachelor's degree or at least 6 years of experience in healthcare, pharmacy benefit management (PBM), managed care, health plans, formulary, pharmacy operations, or a related area.
At least 2 years of leadership, management, project leadership, or people leadership experience.
Experience leading cross-functional initiatives involving multiple stakeholders.
Strong analytical and problem-solving skills, including critical thinking.
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.
Passion for contributing to an organization focused on continuously improving consumer experiences.
For work at home, self-provided internet service must provide at least 25 Mbps download and 10 Mbps upload; wireless, wired cable, or DSL is suggested.
Must work from a dedicated space without ongoing interruptions to protect member PHI/HIPAA information.

Nice To Haves

Experience in formulary management, pharmacy operations, pharmacy benefits management, managed care, or health plan administration.
Experience supporting Medicaid, Medicare, Commercial, or Exchange formulary programs.
Medicare Part D knowledge.
Experience with formulary compliance and regulatory requirements.
Knowledge of utilization management strategies and formulary governance processes.
Experience with data analytics tools such as SQL, Power BI, Tableau, or similar reporting platforms.
Experience leading large-scale implementations, system builds, testing, or operational readiness initiatives.
Master's degree in healthcare administration, business administration, public health, health policy, or a related field.

Responsibilities

Lead formulary development and maintenance activities across applicable products and lines of business.
Oversee operational implementation of formulary changes, coordinating with clinical, configuration, product, and operational teams.
Support development and execution of utilization management programs, including prior authorization, step therapy, and quantity limits.
Evaluate formulary performance and operational impacts through data analysis and reporting.
Ensure compliance with applicable state, federal, and client formulary requirements.
Develop and maintain policies, procedures, and supporting documentation for formulary operations.
Partner with cross-functional stakeholders to support formulary submissions, audits, regulatory reviews, and implementations.
Lead strategic projects and initiatives related to formulary optimization, operational excellence, and process improvement.
Lead, develop, and support a high-performing team by setting expectations, coaching associates, supporting career development, and fostering accountability and engagement.
Manage formulary operations workflows, quality, capacity, training, reporting, and issue resolution.