Formulary Operations Management Professional

Formulary Operations Professional 2

Become a part of our caring community and help us put health first. The Formulary Operations Professional 2 is an integral part of the Clinical Drug Policy Management team which ensures synchronization of formulary utilization management policies across multiple systems. Humana is seeking a positive and proactive individual to contribute to this high performing team which drives clinical and operational execution of Humana's clinical drug policies.

Responsibilities include : creation and maintenance of clinical tools which help facilitate clinical medication review decision making; operationalizing prior authorization criteria into Humana systems in alignment with Humana's Pharmacy and Therapeutics Committee and in collaboration with healthcare professionals, pharmacists, and other business functions; and developing key performance indicators and plans to improve overall process improvements and efficiency.

Understands department, segment, and organizational strategy and operating objectives, including their linkages to related areas. Makes decisions regarding own work methods, occasionally in ambiguous situations, and requires minimal direction and receives guidance where needed.

Required qualifications include : Bachelor's Degree or equivalent experience in a healthcare setting; working knowledge of all Microsoft Office applications; strong organizational skills; strong written and verbal communication skills; ability to work independently and within a team setting to achieve goals and meet deadlines; and prior demonstrated experience with process improvement and documentation.

Desired qualifications include : proficiency in Power Platform, Power BI, Power Apps; Six Sigma Green belt certification; three years' experience in pharmacy benefits management; and three years of experience in a health services or technical field.

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 : $65,000 - $88,600 per year. This job is eligible for a bonus incentive plan.

Humana, Inc. and its affiliated subsidiaries offers competitive benefits that support whole-person well-being. Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off, disability, life insurance and many other opportunities.

Application Deadline : 10-23-2025

Humana Inc. 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, 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. Humana complies with all applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, sex, sexual orientation, gender identity or religion. We also provide free language interpreter services.