Associate Director, Formulary Operations Management

Bazeta; United States; Remote; USD 126,000 - 174,000; Full time

Job summary

Humana is seeking an Associate Director of Formulary Operations Management in the United States. This role develops, implements, maintains, and governs pharmacy formularies and utilization management strategies across lines of business, partnering with clinical, regulatory, analytics, and product teams to ensure compliant and effective formulary decisions.

The position requires leadership to translate formulary strategy into operational excellence, oversee operations, and drive improvements.

Qualifications

• Bachelor's degree in healthcare or related field.
• 6+ years in healthcare/PBM/managed care.
• 2+ years of leadership experience.
• Strong analytical and problem-solving skills.
• Excellent executive-level communication.

Responsibilities

• Lead formulary development and maintenance across products and lines of business.
• Oversee operational implementation of formulary changes with cross-functional teams.
• Support utilization management programs (prior authorization, step therapy, quantity limits, coverage).
• Evaluate formulary performance through data analysis and reporting.
• Ensure compliance with state, federal, and client formulary requirements.
• Develop and maintain policies and procedures for formulary operations.
• Collaborate with stakeholders on submissions, audits, regulatory reviews, and implementations.
• Lead strategic projects related to formulary optimization and process improvement.
• Lead and develop a high-performing team with clear expectations and accountability.

Skills

Leadership

Cross-functional collaboration

Analytical thinking

Project management

Executive communication

Stakeholder management

Education

Bachelor's degree

Master's degree (preferred)

Tools

SQL

Power BI

Tableau

Excel

Job description

# Associate Director, Formulary Operations ManagementUnited States2 hours agoID 5520850$126,300 Salary## DetailsEmployment type: Full-timeRemote: YesSalary from: 126,300Salary to: 173,700Company: Humana## DescriptionBecome a part of our caring community The Associate Director, Formulary Operations Management is responsible for the development, implementation, maintenance, and governance of pharmacy formularies and utilization management strategies across lines of business. This role partners with clinical, operational, regulatory, analytics, and product teams to ensure formulary decisions are accurately implemented, compliant with regulatory requirements, and aligned with organizational goals. The Associate Director, Formulary Operations Management requires a solid understanding of how organizational capabilities interrelate across departments and serves as a key leader in translating formulary strategy into operational excellence. The Associate Director, Formulary Management leads formulary operations implementation and maintenance activities, ensuring alignment with regulatory requirements, business objectives, and member needs. This role collaborates with internal and external stakeholders to implement formulary strategies, oversee utilization management initiatives, support regulatory submissions, and ensure accurate implementation of formulary and coverage decisions. Associate Director is accountable for formulary operations workflow, quality, capacity, training, reporting, issue resolution, and people leadership. This role will work during standard Eastern Time business hours. Key Responsibilities: • Lead formulary development and maintenance activities across applicable products and lines of business. • Oversee operational implementation of formulary changes, including coordination with clinical, configuration, product, and operational teams. • Support the development and execution of utilization management programs, including, but not limited to, 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 clear expectations, coaching associates, supporting career development, and fostering accountability, engagement, and collective success. Use your skills to make an impact Required Qualifications • 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 • Must be passionate about contributing to an organization focused on continuously improving consumer experiences Preferred Qualifications • 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...