Humana Pharmacy Segment Management Strategic Consultant in Louisville, Kentucky

Role: Strategic Consultant, Pharmacy Segment Management Assignment: Pharmacy Segment Management Location: Louisville, KY

Role Description As a leader on the Healthcare Services (HCS) Pharmacy Segment Management team, you will be accountable for managing all aspects of the Medicare PDP business within HCS . You will be responsible for managing HCS’s relationship with Humana’s Medicare PDP segment (i.e., the health plan), effectively communicating and championing the PDP strategy within HCS, managing segment trend expectations, resolving issues, supporting the development of HCS products, services, and value propositions, and aligning administrative expenses.

Role activities include: * In collaboration with Humana’s Medicare PDP segment and HCS leaders, define the strategic direction and new business opportunities for PDP.

  • Monitor the external environment/competitive landscape; identify opportunities to differentiate Humana from the industry.

  • Support completion of the annual Medicare PDP bid. Ensure key HCS stakeholders are aligned, including but not limited to: HCS Clinical Strategies, Pharmacy Networks, Trade Relations, Pharmacy Analytics and Reporting, Finance, Regulatory Affairs, Regulatory Compliance, and Business Improvement.

  • Partner with Humana’s Medicare PDP team on bid assumptions, benefits and premiums.

  • Manage relationships with external stakeholders, partners, and suppliers, as needed.

  • Collaborate across the enterprise, effectively prioritizing, and removing barriers that hinder performance.

  • Primary responsibility for PDP business performance & financial performance within HCS.

  • Provide oversight for drug spend and drivers of trends

  • Represent HCS at Corporate Medicare Trend Committees/Summits for PDP

    o Articulate the PDP strategic direction to stakeholders and ensure segment deliverables are met from key areas:

    o Formulary Planning, Strategy and Activation

    o UM programs

    o Plan Build/PBM Operations

    o HCS Compliance

    o Audits

    o Pharmacy Professional Affairs

    o Go-Live, ANOC/EOC, Transition Policy

    o HCS Business Improvement

    o Web Strategy, Design and Implementation Communications and Marketing

    o Finance/Administrative Costs

    o Clinical Programs and Strategy

    o Pharmacy Networks

    o Manufacturer Contracting

    o HP/HSP Operations

  • Ensure HCS stakeholders are kept informed of, and are aligned with, market and business development opportunities.

  • Ensure pharmacy strategy is aligned with segment performance (i.e. generic dispense rate, mail-order rate, customer experience and retention).

Role Essentials: * Bachelor’s degree in business, finance, pharmacy or a related field

  • 8 years of Pharmacy / PBM experience.

  • 6 years of Medicare PDP experience.

  • Success leading teams

  • Client Management/Consulting experience.

  • Strategic Planning experience

  • Product Development & Trend Management experience

  • Regulatory (CMS, DOI…etc.) experience

  • Project Management & Process expertize.

  • Professional image and excellent communication skills required

  • Possess a solid understanding of operations, technology, communications and processes.

Role Desirables:

  • Master’s Degree in Business Administration or a related field

  • PMP certification a plus

  • Six Sigma Certification also a plus

Title: Pharmacy Segment Management Strategic Consultant

Location: KY-Louisville

Requisition ID: 191997

Humana Inc., headquartered in Louisville, Ky., is a leading health care company that offers a wide range of insurance products and health and wellness services that incorporate an integrated approach to lifelong well-being. By leveraging the strengths of its core businesses, Humana believes it can better explore opportunities for existing and emerging adjacencies in health care that can further enhance wellness opportunities for the millions of people across the nation with whom the company has relationships.

Humana complies with all applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex. We also provide free language interpreter services. See our full accessibility rights information and language options.