Formulary Operations Management Professional 2

Louisville, Kentucky

Posted in Insurance
9 days ago

Job Info


The Formulary Operations Management Professional 2 provides clinical and operational support for build, maintenance, submission, and management of formularies and drug lists. Work responsibilities are varied and frequently require interpretation and independent determination of the appropriate courses of action. Ensures accuracy of formularies and utilization management (UM) criteria in the Formulary Enterprise and claims processing systems. Collaborates with healthcare professionals, pharmacists, and other business functions to operationalize formularies. Performs formulary analysis and reporting to ensure optimal operational flow. Develops key performance indicators and plans to improve overall processes and efficiency. Creates and maintains formulary management process and training documentation.
Provides excellent service to our customers and stakeholders. This individual will support Humana's Commercial and Medicaid lines of business.


    Key Competencies:
    • Understands department, segment, and organizational strategy and operating objectives, including their linkages to related areas
    • Understands Humana's business processes, systems, tools, regulations and structure
    • Demonstrates appropriate knowledge of company customers and/or business partners and their needs and requirements
    • Makes decisions regarding own work methods, occasionally in ambiguous situations
    • Follows established guidelines/procedures
    • Develops and optimizes end-to-end processes
    • Motivates and inspires teammates to increase engagement, productivity and personal achievement
    • Actively listens and ensures understanding regardless of the communication vehicle
    • Effectively leverages available resources (financial, people, time) to accomplish objectives
    Required Qualifications
    • Bachelor's degree or 3+ years equivalent experience in technical skill application
    • Strong consultative skills and relationship building skills
    • Prior demonstrated experience with process improvement or process design and implementation roles
    • Excellent data analysis and experience working with Microsoft Office applications, including Excel, Access, Word, Project and Visio
    • Ability to work on multiple projects
    • Ability to successfully handle change in a fast paced environment
    Preferred Qualifications
    • Lean, Green Belt experience and/or certifications
    • Previous experience with pharmacy and/or benefits management
    • Previous Commercial, Medicare and/or Medicaid experience
    • Excellent written and verbal communication skills
    • Excellent planning and organizational skills
    Scheduled Weekly Hours


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