Formulary and Medical Strategies Senior Professional - Veterans Staffing : Job Details

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.

• 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

• 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 applications, including Excel, Word, Powerpoint, Project, and Visio.

• Master's degree
• Knowledge of Medicaid business as it relates to pharmacy or medical drugs
• Experience in finance and/or business-related pharmacy practice
• Lean certification or Six Sigma Black belt

Additional Information: As part of our hiring process for this opportunity, we will be using an interviewing technology called HireVue to enhance our hiring and decision-making ability. HireVue allows us to quickly connect and gain valuable information from you pertaining to your relevant skills and experience at a time that is best for your schedule.

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. Satellite, cellular and microwave connection can be used only if approved by leadership.
• Employees who live and work from Home in the state of California, Illinois, Montana, or South Dakota will be provided a bi-weekly payment for their internet expense.
• Humana will provide Home or Hybrid Home/Office employees with telephone equipment appropriate to meet the business requirements for their position/job. 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 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. $86,300 - $118,700 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, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.

Application Deadline: 09-04-2025

About us Humana Inc. (NYSE: HUM) is committed to putting health first for our teammates, our customers and our company. Through our Humana insurance services and 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, Medicaid, families, individuals, military service personnel, and communities at large.

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.