Remote Senior Risk & Compliance Leader - Pharmacy Solutions

Humana Inc; United States; On-site; USD 86,000 - 119,000; Full time

Benefits offered by this job

Medical, dental and vision benefits

401(k) retirement savings plan

Paid time off

Disability insurance

Life insurance

Bonus plan

Job summary

Humana, Inc. via CenterWell Senior Primary Care seeks a Senior Risk Management Professional to identify, analyze, and mitigate risks across Humana Pharmacy Solutions.

You will partner with stakeholders to track issues, report on compliance, and guide corrective actions in a risk-aware, compliant environment. The role requires a background in compliance, risk management or internal audit, plus pharmacy claims operations experience.

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 in facilitating and managing projects across teams
• Ability to handle multiple tasks and deadlines with attention to detail
• Strong organizational, interpersonal, and communication skills

Responsibilities

• Design, implement, and perform targeted monitoring to identify risks, promote consistency, and support remediation of issues within the Pharmacy space.
• Support audit and readiness activities through identification of risk areas, development of recommendations, and review of audit outputs and corrective actions.
• Oversee issue and remediation tracking, monitoring, and escalation, including documentation in Humana’s governance, risk, and compliance systems.
• Develop executive-level dashboards and reporting to summarize compliance risks, key metrics, issue remediation, and emerging concerns.
• Provide Second Line oversight and guidance to business owners on preventive measures and corrective actions to support compliance with regulations, guidance, and contractual requirements.
• Partner with business owners across Humana Pharmacy Solutions, Enterprise Compliance, Risk Operations, and vendor teams to identify, assess, track, elevate report compliance risks and issues.
• Oversee the implementation of new CMS and Medicaid contract requirements across operational areas in HPS.
• Use your skills to make an impact

Skills

Risk management

Compliance

Strong communication

Project management

Attention to detail

Education

Bachelor’s degree or equivalent

Tools

Excel

Job description

Humana, Inc. via CenterWell Senior Primary Care seeks a Senior Risk Management Professional to identify, analyze, and mitigate risks across Humana Pharmacy Solutions.

You will partner with stakeholders to track issues, report on compliance, and guide corrective actions in a risk-aware, compliant environment. The role requires a background in compliance, risk management or internal audit, plus pharmacy claims operations experience.