Associate Director, Formulary Operations Management

309 Humana Pharmacy Solutions, Inc.; United States; Remote; USD 126,000 - 174,000; Full time

Job summary

Humana, Inc. is seeking an Associate Director, Formulary Operations Management to lead the development, implementation, maintenance, and governance of pharmacy formularies.

You will partner with clinical, regulatory, analytics, and product teams to ensure formulary decisions are accurate, compliant, and aligned with organizational goals. This role leads formulary operations, utilization management initiatives, and regulatory submissions while ensuring a high-performing team operates with

Qualifications

• Bachelor's degree or 6+ years in healthcare, PBM, managed care, or related field.
• 2+ years of leadership, management, or people leadership experience.
• Experience leading cross-functional initiatives with multiple stakeholders.
• Strong analytical, organizational, and project management skills.
• Excellent verbal and written communication, including executive-level language.
• Proficiency with Microsoft Office applications (Excel, PowerPoint, Word, Teams).

Responsibilities

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

Skills

Leadership

Cross-functional collaboration

Analytical skills

Project management

Communication

Education

Bachelor's degree

Tools

Excel

PowerPoint

Word

Teams

Job description

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.

This role 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 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.

Required Qualifications

• Bachelor's degree OR 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 Medicare Part D knowledge
• Experience with formulary compliance and regulatory requirementsKnowledge 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

Work at Home Requirements

To ensure Home or Hybrid Home/Office employees’ ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office employees must meet the following criteria: At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is required; wireless, wired cable or DSL connection is suggested. In certain roles, the minimum recommended internet speed required by Humana may not be sufficient for business needs. Humana reserves the right to require associates to upgrade their internet service if necessary. Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information.

Travel

While this is a remote position, occasional travel to Humana's offices for training or meetings may be required.

Scheduled Weekly Hours 40 Pay Range

Scheduled Weekly Hours 40 Pay Range The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc.

$126,300 - $173,700 per year This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance.

Description of Benefits

Humana, Inc. and its affiliated subsidiaries (collectively, “Humana”) offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.

Application Deadline

11-13-2026

About us

Humana: Humana Inc. (NYSE: HUM) is a leading U.S. healthcare company. Through our Humana insurance services and our CenterWell healthcare services, we make it easier for the millions of people we serve to achieve their best health – delivering the care and service they need, when they need it. These efforts are leading to a better quality of life for people with Medicare and Medicaid, families, individuals, military service personnel, and communities at large. Learn more about what we offer atHumana.comand atCenterWell.com.

Equal Opportunity Employer

It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status. It is also the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and VEVRAA, to employ and to advance in employment individuals with disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment.