Senior Pharmacy Risk & Compliance Leader

Humana Inc; Juneau (AK); Remote; USD 86,000 - 119,000; Full time

Benefits offered by this job

Bonus incentive plan

Job summary

Humana, Inc. is seeking a Senior Risk Management Professional to identify and minimize risk in the Pharmacy Solutions space. You will analyze loss sources, implement controls, and partner with business owners to support compliance and reporting.

The role handles moderately to complex issues, develops dashboards, and guides risk-related initiatives across Risk Operations and vendor teams. Remote position with some travel; 40-hour week.

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 demonstrated 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, escalation, and report compliance risks and issues.
• Oversee the implementation of new CMS and Medicaid contract requirements across operational areas in HPS.

Skills

Risk management

Compliance

Project management

Data analysis

Communication

Education

Bachelor’s degree or equivalent

5+ years of related experience in PBM operations or risk management

Tools

Excel

Job description

Humana, Inc. is seeking a Senior Risk Management Professional to identify and minimize risk in the Pharmacy Solutions space. You will analyze loss sources, implement controls, and partner with business owners to support compliance and reporting.

The role handles moderately to complex issues, develops dashboards, and guides risk-related initiatives across Risk Operations and vendor teams. Remote position with some travel; 40-hour week.