Formulary Strategy Pharmacist Lead

San Antonio, Texas, United States

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Not SpecifiedCompensation

Mid-level (3 to 4 years), Senior (5 to 8 years)Experience Level

Full TimeJob Type

UnknownVisa

Health Insurance, Managed CareIndustries

Requirements

Candidates must possess a Pharmacy Degree from an accredited School of Pharmacy, with at least 3 years of clinical experience in managed care or a related pharmacy field. Experience in formulary strategy/development and CMS Part D guidance is required, along with strong analytical, problem-solving, and communication skills. Preferred qualifications include an MBA, BPS Board Certification, and pharmacy practice residency or similar experience.

Responsibilities

The Formulary Strategy Pharmacist Lead will develop and implement formulary strategies to mitigate cost trends and improve health outcomes, utilizing clinical and financial data. This role involves translating complex information into clear, data-driven messages for executive audiences, collaborating with various departments to support formulary decisions, and ensuring accurate implementation of formulary changes. They will also leverage market trends and competitive intelligence to inform strategy development.

Skills

Pharmacy

Managed Care

PBM

Formulary Strategy

Cost Mitigation

Health Outcomes

Clinical Data Analysis

Financial Data Analysis

Market Trends

Competitive Intelligence

Communication

Stakeholder Management

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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