Become a part of our caring community and help us put health first
 

The Senior Professional collaborates with healthcare professionals, pharmacists, and other business functions to implement formulary and medical strategies for the Medicaid line of business. Makes decisions on moderately complex to complex issues regarding technical approach for project components, and work is performed without direction. Exercises considerable latitude in determining objectives and approaches to assignments.

The Senior Formulary Operations Management Professional collaborates with healthcare professionals, pharmacists, and other business functions to implement formulary and medical strategies for the Medicaid line of business.

• Utilizes broad understanding of pharmacy, managed care, PBM, market and regulatory insights to support the implementation of formulary and medical strategies to mitigate Humana’s costs and trend while improving our member’s health outcomes and costs.
• Performs formulary and medical drug list analysis and reporting that assist in the decision making of Medicaid drug strategies.
• Works across multiple departments to support Medicaid drug list changes for member communications (monthly, quarterly, and ad-hoc).
• Prepares presentations to executive-level audiences on our Medicaid strategies.
• Works with appropriate business partners to ensure accurate and timely implementation of formulary and medical strategies.
• Ensures Humana’s business processes are compliant with state Medicaid contracts and provides appropriate attestation and evidence for audits and accreditation.
• Develops key performance indicators and plans to drive overall process improvements and efficiency for the Medicaid line of business.
• Serves as a key representative for Medicaid strategies across the organization.
• Makes decisions on moderately complex to complex issues regarding technical approach for project components, and work is performed without direction. Exercises considerable latitude in determining objectives and approaches to assignments.
• Drives for standardization and transparency with an aggressive focus on process documentation.

Key Competencies:

• Acts Strategically: Has vision, anticipates future consequences and trends accurately; has broad knowledge and perspective; creates competitive and breakthrough strategies and plans.
• Builds Trust: You honor your word by doing what you say you are going to do.
• Drives for Excellence: You are a continuous learner who encourages others to learn. By constantly upgrading your own work, you achieve results and outperform the competition.
• Innovates: Introduces or develops new ideas and processes which improve performance or productivity.
• Implementation/Execution: You are good at organizing and managing multiple priorities and/or projects by using appropriate methodologies and tools.
• Problem Solving: You are a problem solver with the ability to encourage others in collaborative problem solving. Acting as both a broker and consultant regarding resources, you engage others in problem solving without taking over.

Use your skills to make an impact
 

Required Qualifications:

• Bachelor’s degree or equivalent
• 3+ years of experience in managed care or other pharmacy related field
• 3+ years of experience of leading successful implementation of projects
• 3+ years of technical experience required for data analysis and reporting
• Experience in analysis and problem-solving
• Excellent oral and written communication skills, previous experience presenting and interacting with senior leadership
• Flexible, dynamic personality who works well in a team environment and is also an individual contributor
• Ability to prioritize, organizes, and executes effective time management
• Ability to assimilate, analyze, draw conclusions, and make recommendations from complex data
• Ability to work in either a team or an individual capacity to achieve goals and meet deadlines
• Successful track record in facilitating and consulting across teams and managing projects
• Comprehensive knowledge of all Microsoft Office a