Formulary Operations Professional 2

Employment Type: Full-time Scheduled Weekly Hours: 40 Pay Range: $65,000 - $88,600 per year Location Type: Remote (occasional travel to Humana's offices for training or meetings may be required) Application Deadline: 07-30-2025

Position Overview

Become a part of our caring community and help us put health first. The Formulary Operations Professional 2 is an integral part of the Clinical Drug Policy Management team, ensuring the synchronization of formulary utilization management policies across multiple systems. Humana is seeking a positive and proactive individual to contribute to this high-performing team, driving clinical and operational execution of Humana's clinical drug policies.

Responsibilities

• Responsible for the creation and maintenance of clinical tools that facilitate clinical medication review decision-making.
• Responsible for operationalizing prior authorization criteria into Humana systems in alignment with Humana’s Pharmacy and Therapeutics Committee and in collaboration with healthcare professionals, pharmacists, and other business functions.
• Develops key performance indicators and plans to improve overall process improvements and efficiency.
• Understands department, segment, and organizational strategy and operating objectives, including their linkages to related areas.
• Makes decisions regarding own work methods, occasionally in ambiguous situations, requiring minimal direction and receiving guidance where needed.
• Use your skills to make an impact.

Required Qualifications

• Bachelor’s Degree or equivalent experience in a healthcare setting.
• Working knowledge of all Microsoft Office applications, including Word, Access, and Excel.
• Strong organizational skills.
• Strong written and verbal communication skills.
• Works well independently and within a team setting to achieve goals and meet deadlines.
• Prior demonstrated experience with process improvement and documentation.

Desired Qualifications

• Proficiency in Power Platform, Power BI, Power Apps.
• Six Sigma Green belt certification.
• Three years’ experience in pharmacy benefits management.
• Three years of experience in a health services or technical field.

About Humana

Humana, Inc. and its affiliated subsidiaries (collectively, “Humana”) offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance, and many other opportunities. This job is eligible for a bonus incentive plan based on company and/or individual performance.

About CenterWell Pharmacy

CenterWell Pharmacy provides convenient, safe, reliable pharmacy services and is committed to excellence and quality. Through our home delivery and over-the-counter fulfillment services, specialty, and retail pharmacy locations, we provide customers simple, integrated solutions every time. We care for patients with chronic and complex illnesses, as well as offer personalized clinical and educational services to improve health outcomes and drive superior medication adherence.

About CenterWell, a Humana Company

CenterWell creates experiences that put patients at the center. As the nation’s largest provider of senior-focused primary care, one of the largest providers of home health services, and fourth largest p...