Associate Director, Formulary Operations Management

Humana

1d • $126,300 - $173,700 • Remote

About The Position

The Associate Director, Formulary Operations Management is responsible for developing, implementing, maintaining, and governing pharmacy formularies and utilization management strategies across lines of business. The role partners with clinical, operational, regulatory, analytics, product, and other internal and external stakeholders to translate formulary strategy into accurate, compliant operations aligned with organizational goals and member needs.

The Associate Director leads formulary operations implementation and maintenance, including workflow, quality, capacity, training, reporting, issue resolution, and people leadership. The role supports formulary submissions, audits, regulatory reviews, utilization management initiatives, and implementations, and leads strategic projects in formulary optimization, operational excellence, and process improvement. The position works during standard Eastern Time business hours.

This is a remote position with occasional travel to Humana offices for training or meetings. Home or hybrid home/office employees must work from a dedicated space that protects member PHI/HIPAA information and provide internet service with at least 25 Mbps download and 10 Mbps upload speeds.

Requirements

• Bachelor's degree.
• At least 6 years of healthcare, pharmacy benefit management (PBM), managed care, health plan, formulary, pharmacy operations, or related experience.
• 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.

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.
• 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, quantity limits, and coverage.
• 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 workflow, quality, capacity, training, reporting, and issue resolution.

Benefits

• Medical, dental, and vision benefits.
• 401(k) retirement savings plan.
• Paid time off, company and personal holidays, and paid parental and caregiver leave.
• Short-term and long-term disability.
• Life insurance.
• Bonus incentive plan based on company and/or individual performance.

What This Job Offers

• Job Type: Full-time
• Career Level: Director