Senior Formulary Operations Management Professional - Distribution Programs

Profile

Job Information
Humana
Senior Formulary Operations Management Professional - Distribution Programs
in
Louisville
Kentucky
Description
The Senior Distribution Programs Professional provides clinical and operational leadership for the development, maintenance, and publication of Humana's formularies and supplemental drug lists. The Senior Distribution Programs Professional work assignments involve moderately complex to complex issues where the analysis of data, systems, and processes requires an in-depth evaluation of variable factors.
Responsibilities
Responsibilities
Manages the annual execution of the Medicare, Commercial, and Medicaid Printable Drug List (PDL) and Prescription Drug Guide (PDG) programs
Partners with key business stakeholders to drive the PDL/PDG processes end-to-end across all impacted business areas
Develops expertise in Humana's formulary management system and prescription drug data
Leads the development of a strategic plan to improve quality, reduce risk, and increase efficiencies:
Conducts annual competitive analysis, incorporating the findings into a short-term and long-term strategy
Ensures PDLs/PDGs are compliant with all CMS, Department of Insurance and State Requirements
Manages a prioritized list of improvement recommendations
Creates IT initiatives via the Clinical Portfolio to meet strategic and process improvement goals
Conducts systems testing and validation for IT initiatives impacting distribution processes
Partners with key stakeholders to create and maintain end-to-end detailed process flow
Establishes and leads governance meetings
Provides status reports/metrics to executive leadership, compliance and functional area leaders on the strategy for the upcoming year and status / risks / issues for the current year PDL/PDG cycle
Supports Project Manager in the annual creation and deployment of the PDL/PDG by:
Managing business expectations for content, structure, and layout
Leading Quality Control initiatives and processes
Serving as the owner for Healthcare Services Issue Management (HCSIM) process
Oversees and develops the creation and/or maintenance of documented processes and training materials
Responsible for improving and executing the clinical formulary PDG/PDL processes
Completes deliverables associated with the annual project timelines
Develops and executes quality assurance processes to ensure 100% review and accuracy of deliverables
Develops and implements standardized processes
Assists with audit, quality control and issue reporting/remediation activities
Cross trains others on PDL and PDG processes
Competencies
Demonstrates leadership skills and leverages available resources effectively
Establishes clear priorities to deliver results in ambiguous situations
Improves member experience by providing cost effective, compliant PDLs and PDGs
Exhibits strong communication skills and is able to communicate complex information clearly
Demonstrates an ability to problem-solve and investigate/troubleshoot through data analysis or other technical research
Influences others to achieve goals and meet deadlines
Engages associates by gathering multiple viewpoints and establishes trusting and productive relationships with key stakeholders
Models and inspires high integrity, accountability, and initiative
Manages projects, initiatives, milestones, and deliverables effectively
Leverages metrics, stakeholder feedback, and competitive intelligence to identify and implement process improvements
Produces clear, concise process documentation
Works well independently and within a team setting to achieve goals and meet deadlines
Required Qualifications
Bachelor's degree or higher
Strong Project Management skills
Experience in change management techniques and project implementation
Extensive knowledge of process re-engineering techniques
Comprehensive knowledge of all Microsoft Office applications, including Excel, Word, PowerPoint, Project and Visio
Strong consultative skills and relationship building skills
Passionate about contributing to an organization focused on continuously improving consumer experiences
For this job, associates are required to be fully COVID vaccinated or undergo weekly COVID testing and wear a face covering while at work. The weekly testing will need to be done through an approved Humana vendor, and unvaccinated associates should follow all social distancing and masking protocols if they are required to come into a Humana facility or work outside of their home. We are a healthcare company committed to putting health and safety first for our members, patients, associates, and the communities we serve.
If progressed to offer, you will be required to:
Provide proof of full vaccination or commit to testing protocols
*OR  *
Provide proof of applicable exemption including any required supporting documentation
​​Medical, religious, state and remote-only work exemptions are available.
Preferred Qualifications
MBA, Engineering, or IT degree
3 - 5 years of experience of leading successful continuous improvement projects using various process tools (Value Stream Mapping (VSM), Pareto analysis, Fish-bone diagrams, Failure Mode and Effects Analysis (FMEA), etc.)
Pharmacy experience - degree from an accredited college of pharmacy or pharmacy technician certification
Prior management experience
Lean Certification, Six Sigma Green Belt or higher designation
Three years of experience in a health services field
Three years of experience with pharmacy benefits management
Knowledge/experience working with SQL, MS Access
Familiarity with Humana's operating systems
Scheduled Weekly Hours
40

Company info

Sign Up Now - MiamiCrossing.com