Associate Director, Formulary Operations Management

The Associate Director, Formulary Operations Management is responsible for the development, implementation, maintenance, and

governance of pharmacy formularies and utilization management strategies across lines of business. This role partners with clinical,

operational, regulatory, analytics, and product teams to ensure formulary decisions are accurately implemented, compliant with regulatory

requirements, and aligned with organizational goals.

The Associate Director, Formulary Operations Management requires a solid understanding of how organizational capabilities interrelate

across departments and serves as a key leader in translating formulary strategy into operational excellence.

The Associate Director, Formulary Management leads formulary operations implementation and maintenance activities, ensuring alignment with regulatory requirements, business objectives, and member needs. This role collaborates with internal and external stakeholders to implement formulary strategies, oversee utilization management initiatives, support regulatory submissions, and ensure accurate implementation of formulary and coverage decisions. Associate Director is accountable for formulary operations workflow, quality, capacity, training, reporting, issue resolution, and people leadership.

This role will work standard Eastern Time business hours.

• Lead formulary development and maintenance activities across applicable products and lines of business.
• Oversee operational implementation of formulary changes, including coordination with clinical, configuration, product, and operational teams.
• Support the development and execution of utilization management programs, including, but not limited to, prior authorization, step therapy, quantity limits, and coverage
• Evaluate formulary performance and operational impacts through data analysis and reporting.
• Ensure compliance with applicable state, federal, and client formulary requirements.
• Develop and maintain policies, procedures, and supporting documentation for formulary operations.
• Partner with cross-functional stakeholders to support formulary submissions, audits, regulatory reviews, and implementations.
• Lead strategic projects and initiatives related to formulary optimization, operational excellence, and process improvement.
• Lead, develop, and support a high-performing team by setting clear expectations, coaching associates, supporting career development, and fostering accountability, engagement, and collective success.

• Bachelor's degree OR 6 or more years of healthcare, pharmacy benefit management (PBM), managed care, health plan, formulary, pharmacy operations, or related experience
• 2 or more years of leadership, management, project leadership, or people leadership experience
• Experience leading cross-functional initiatives involving multiple stakeholders
• Strong analytical and problem-solving skills
• Strong organizational and project management skills
• Ability to manage multiple priorities and deadlines in a fast-paced environment
• Excellent verbal and written communication skills, including executive-level communication
• Comprehensive knowledge of Microsoft Office applications, including Excel, PowerPoint, Word, and Teams
• Demonstrated ability to influence and drive organizational outcomes
• Strong problem solving, critical thinking and analytical skills
• Must be passionate about contributing to an organization focused on continuously improving consumer experiences

• Experience in formulary management, pharmacy operations, pharmacy benefits management, managed care, or health plan administration
• Experience supporting Medicaid, Medicare, Commercial, or Exchange formulary programs

Medicare Part D knowledge

• Experience with formulary compliance and regulatory requirements
• Knowledge of utilization management strategies and formulary governance processes
• Experience with data analytics tools such as SQL, Power BI, Tableau, or similar reporting platforms
• Experience leading large-scale implementations, system builds, testing, or operational readiness initiatives
• Master's degree in healthcare administration, Business Administration, Public Health, Health Policy, or a related field

Work at Home Requirements:
To ensure Home or Hybrid Home/Office employees’ ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office employees must meet the following criteria:
At minimum, a…