Associate Director, Formulary Operations Management

The Associate Director, Formulary Operations Management is responsible for developing, implementing, maintaining, and governing 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 organisational goals.

The Associate Director, Formulary Operations Management requires a solid understanding of how organisational capabilities interrelate across departments and serves as a key leader in translating formulary strategy into operational excellence.

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 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 organisational 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 organisational outcomes.
• Strong problem-solving, critical thinking, and analytical skills.

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 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.

Work Arrangements:

• Remote position with occasional travel to Humana's offices for training or meetings.
• Must have a dedicated workspace with reliable internet connectivity (minimum 25 Mbps download and 10 Mbps upload).

Scheduled Weekly Hours:

• 40 hours per week.

Pay Range:

• $126,300 - $173,700 per year.

Benefits:

• 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.