Senior Pharmacy Risk & Compliance Lead (Remote)

Humana Inc; Honolulu (HI); Remote; USD 86,000 - 119,000; Full time

Job summary

Humana Inc. is seeking a Senior Risk Management Professional to identify, analyze, and minimize risk within the Humana Pharmacy Solutions organization, partnering with Risk Operations, CenterWell, and vendor teams to track and report compliance issues affecting pharmacy operations.

The role requires experience in compliance, risk management, or internal audit, and the ability to design monitoring, dashboards, and reporting for executive leadership.

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.
• Experience in process improvement with measurable results.
• Proven track record in facilitating and managing projects across teams.
• Strong organizational, interpersonal, and communication skills.

Responsibilities

• Design, implement, and perform targeted monitoring to identify risks and support remediation in the Pharmacy space.
• Support audit and readiness activities through risk identification and remediation recommendations.
• Oversee issue tracking, monitoring, and escalation in governance, risk, and compliance systems.
• Develop executive dashboards and reporting on compliance risks and metrics.
• Provide guidance to business owners on preventive and corrective actions for regulatory compliance.
• Collaborate with Humana Pharmacy Solutions, Enterprise Compliance, Risk Operations, and vendors to report risks and issues.
• Oversee implementation of CMS and Medicaid contract requirements across operations.

Skills

Communication skills

Organizational skills

Interpersonal skills

Pharmacy claims processing

Process improvement

Project management

Education

Bachelor’s degree or equivalent in related field

Job description

Humana Inc. is seeking a Senior Risk Management Professional to identify, analyze, and minimize risk within the Humana Pharmacy Solutions organization, partnering with Risk Operations, CenterWell, and vendor teams to track and report compliance issues affecting pharmacy operations.

The role requires experience in compliance, risk management, or internal audit, and the ability to design monitoring, dashboards, and reporting for executive leadership.