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Director, Pharmacy Clinical Formulary and Medical Drug Strategies

Humana

Location: Tampa, FL 33603
Type: Non-Remote
Posted on: September 21, 2022
This job is no longer available from the source.
**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 https://www.humana.com/legal/accessibility-resources?source=Humana_Website. <>
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