Director Pharmacy Clinical Formulary and Medical Drug Strategies

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Description

The Director, Pharmacy Clinical Formulary and Medical Drug Strategies oversees and drives the pharmacy and medical drug formulary strategies across all lines of business (Medicare, Commercial, Medicaid). This position will work and collaborate with leaders across the Humana enterprise, HPS executive leaders, Trade Relations, Clinical, Analytics, Actuaries, and Operation functions to develop, implement, and execute the formulary strategies.

Responsibilities

The Director, Pharmacy Clinical Formulary and Medical Drug Strategies requires a broad understanding of pharmacy, managed care, PBM, market and regulatory insights to develop and/or implement formulary strategies to mitigate cost while improving health outcomes. He/she requires an in-depth understanding of how organization capabilities interrelate across the function and segment. The role requires a clinician and an effective operator to execute on the formulary strategies for all lines of business.

Responsibilities


Utilizes broad understanding of pharmacy, managed care, PBM, market and regulatory insights to lead the development of pharmacy formulary and medical drug strategies to mitigate Humana's costs and trend while improving our member's health outcomes and costs
Proactively develops key opportunities leveraging competitive intelligence insights, market trends, industry feedback to meet key objectives and devise new or improved product offerings
Facilitate and provide transparency to informed formulary decisions made consistent with our formulary guiding principles and enterprise objectives
Drive the use of evidence-based guidelines, robust modeling and analytics to support formulary and medical drug strategy development and decisions
Driving processes to evaluate and monitor effectiveness of formularies and related programs against specific formulary objectives, including formulary adherence reporting and remediation
Ensures that formulary development compliance standards set by regulators, URAC, and NCQA as defined in policies, that procedures are documented, that those processes are followed and audited
Partners with clinical, business professionals, actuaries and operations in formulary strategy development, insights and outcome measurement
Oversee formulary communication strategy and implementation. Collaborates with other teams to communicate and educate members, providers, pharmacies, and internal business partners on Humana's formularies, drug lists and formulary initiatives as required by CMS and States.
Monitors the formulary change process to minimize member disruption but drive value and better member outcomes
Works with appropriate business partners to ensure accurate and timely implementation of formulary decisions
Participates in Humana committees as appropriate
Promotes a continuous process improvement mindset, with a focus on comprehensive process documentation and quality
Advocates for Humana's clinical formulary and medical drug strategy in internal and external forums


Required Qualifications


Pharmacy Degree from an accredited School of Pharmacy
Clear and active Pharmacist license in the state(s) in which you are required to practice
Eight (8) years of clinical experience in managed care or equivalent experience
Five(5) years of formulary experience or equivalent experience
Five (5) years' experience in effectively leading direct reports and cross-functional teams
Experience developing and leading successful strategies
Must be passionate about contributing to an organization focused on continuously improving consumer experiences
Very disciplined; has the ability to manage competing priorities and operate effectively within a large and complex organizational structure
Ability to influence and build relationships with people across all levels and organizations internally and externally


Preferred Qualifications


MBA, pharmacoeconomics or health outcomes training
Board Certified Pharmacotherapy Specialist
Experience in finance and/or business-related pharmacy practice


Scheduled Weekly Hours

40

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. See our ****

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