Formulary and Medical Strategies Senior Professional

San Antonio, Texas, United States

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Not SpecifiedCompensation

Senior (5 to 8 years)Experience Level

Full TimeJob Type

UnknownVisa

Health Insurance, Managed CareIndustries

Requirements

Candidates must possess a Bachelor's degree or equivalent, with at least 3 years of experience in managed care or a related pharmacy field. Required experience includes leading successful project implementations, technical data analysis and reporting, and analysis and problem-solving. Strong skills in communication, presenting to senior leadership, prioritizing, organizing, effective time management, and analyzing complex data are essential. The ability to work collaboratively or independently to achieve goals and meet deadlines, along with a successful track record in facilitating and consulting across teams, is also necessary.

Responsibilities

The Senior Professional will collaborate with healthcare professionals, pharmacists, and business functions to implement formulary and medical strategies for the Medicaid line of business. This involves utilizing a broad understanding of pharmacy, managed care, PBM, market, and regulatory insights to mitigate costs and trend while improving member health outcomes. Responsibilities include performing formulary and medical drug list analysis and reporting, supporting Medicaid drug list changes for member communications, and preparing presentations for executive-level audiences. The role also entails ensuring accurate and timely implementation of strategies, maintaining compliance with state Medicaid contracts, developing KPIs for process improvements, and driving standardization and transparency through process documentation.

Skills

Formulary Management

Medical Strategy

Pharmacy

Managed Care

PBM

Regulatory Insights

Drug List Analysis

Reporting

Process Improvement

Medicaid Contracts

Audits

Accreditation

Presentation Skills

Cross-functional Collaboration

Humana

Health insurance provider for seniors and military

About Humana

Humana provides health and well-being services, focusing on Medicare Advantage plans for seniors, military personnel, and communities. Their plans include HMO, PPO, and PFFS options, designed to improve health outcomes through comprehensive and flexible coverage. Humana's revenue comes from government contracts and member premiums, and they aim to maintain high renewal rates by offering quality service and competitive benefits. The company stands out by fostering a culture of inclusivity and belonging among its employees, while also ensuring accessibility for all members, including offering free language interpreter services. Humana's goal is to deliver value to its members through an extensive provider network and innovative health solutions.

Louisville, KentuckyHeadquarters

1961Year Founded

IPOCompany Stage

Social Impact, HealthcareIndustries

10,001+Employees

Risks

Potential over-reliance on AI could disrupt operations if systems fail or are compromised.

Rising medical costs and tightening Medicare reimbursements may strain financial performance.

Leadership change with new CEO Jim Rechtin could lead to strategic disruptions.

Differentiation

Humana is a leader in Medicare Advantage plans, focusing on seniors and military personnel.

The company emphasizes inclusivity, offering free language interpreter services for accessibility.

Humana leverages AI and cloud technologies through a partnership with Google Cloud.

Upsides

Humana's investment in Healthpilot enhances digital enrollment for Medicare options.

The company is the first insurer to cover TMS therapy for adolescent depression.

Humana's focus on value-based care aims to improve outcomes for kidney disease patients.

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