Remote Senior Risk & Compliance Leader - Pharmacy Ops

Humana Inc; Lincoln (NE); À distance; USD 86 000 - 119 000; Plein temps

Avantages offerts par ce poste

Bonus eligibility

Résumé du poste

Humana Inc. is seeking a Senior Risk Management Professional to identify and minimize risks within the Humana Pharmacy Solutions space.

You will partner with business owners and risk teams to track, report, and remediate compliance issues across initiatives, including CMS and Medicaid requirements. This role emphasizes risk assessment, executive reporting, and cross-functional collaboration with Risk Operations and vendor teams.

Qualifications

• Bachelor's degree or equivalent, or 5+ years of related experience in PBM operations or risk management.
• 2+ years of pharmacy claims processing experience.
• Process improvement experience with measurable results.
• Successful track record coordinating projects across teams.
• Ability to manage multiple tasks and deadlines with attention to detail.
• Strong organizational and communication skills.

Responsabilités

• Design, implement, and perform targeted monitoring to identify risks and support remediation within the Pharmacy space.
• Support audit readiness through risk area identification and corrective actions.
• Oversee issue tracking, remediation, and escalation in governance systems.
• Develop executive dashboards and reports on compliance risks and metrics.
• Provide second-line oversight on preventive measures and corrective actions.
• Partner with Humana Pharmacy Solutions, Risk Operations, and vendor teams to track and report compliance risks.
• Oversee implementation of CMS and Medicaid contract requirements across operations.

Connaissances

Bachelor's degree

Risk management

PBM operations

Pharmacy claims processing

Project management

Communication

Attention to detail

Organizational skills

Formation

Bachelor's degree or equivalent

Outils

Excel

Description du poste

Humana Inc. is seeking a Senior Risk Management Professional to identify and minimize risks within the Humana Pharmacy Solutions space.

You will partner with business owners and risk teams to track, report, and remediate compliance issues across initiatives, including CMS and Medicaid requirements. This role emphasizes risk assessment, executive reporting, and cross-functional collaboration with Risk Operations and vendor teams.