Senior Pharmacy Risk & Compliance Leader (Remote)

Humana Inc; Augusta (ME); Remote; USD 86,000 - 119,000; Full time

Job summary

Humana Inc. CenterWell Senior Primary Care seeks a Senior Risk Management Professional to identify and analyze loss sources, minimize risk, and support compliance across the Humana Pharmacy Solutions space.

You will partner with Risk Operations, vendor teams, and business owners to track, resolve, and report on identified risks. The role requires experience in compliance, risk management, or internal audit, and proficiency in using risk data to drive corrective actions and governance.

Qualifications

• Bachelor’s degree or 5+ years of related PBM/risk management experience.
• 2+ years of pharmacy claims processing experience.
• Experience improving processes with measurable results.
• Proven ability to lead cross-functional projects.
• Excellent multitasking, time management, and attention to detail.
• Strong organizational, interpersonal, and communication skills.

Responsibilities

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

Skills

Risk management

Pharmacy claims

Process improvement

Project management

Multitasking

Communication

Organizational skills

Education

Bachelor's degree or equivalent

Tools

Excel

Job description

Humana Inc. CenterWell Senior Primary Care seeks a Senior Risk Management Professional to identify and analyze loss sources, minimize risk, and support compliance across the Humana Pharmacy Solutions space.

You will partner with Risk Operations, vendor teams, and business owners to track, resolve, and report on identified risks. The role requires experience in compliance, risk management, or internal audit, and proficiency in using risk data to drive corrective actions and governance.