Senior Risk Management Professional
New
H
HumanaPharmacy compliance
Source API remote eligibility restrictions: United StatesFull-TimeSenior
SalaryUSD 86300 - 118700 / year
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Job Details
- Experience
- Bachelor’s degree or equivalent, or 5+ years of related experience in PBM operations or risk management; 2+ years of pharmacy claims processing experience
- Required Skills
- Project ManagementMicrosoft ExcelComplianceRisk ManagementProcess improvement
Requirements
- Bachelor’s degree or equivalent, or 5+ years of related experience in PBM operations or risk management.
- At least 2 years of pharmacy claims processing experience.
- Process improvement experience with demonstrated measurable results.
- A successful track record facilitating and managing projects across teams.
- Ability to handle multiple tasks and deadlines with attention to detail.
- Strong organizational, interpersonal, and communication skills.
- Knowledge of Medicare and Medicaid regulations is preferred.
- Experience using Excel and other tools to analyze complex data and generate organized results is preferred.
- Meet the home internet requirements of at least 25 Mbps download and 10 Mbps upload.
- Work from a dedicated space without ongoing interruptions to protect member PHI/HIPAA information.
Responsibilities
- Design, implement, and perform targeted monitoring to identify risks, promote consistency, and support remediation in the Pharmacy space.
- Support audit and readiness activities by identifying risk areas, developing recommendations, and reviewing audit outputs and corrective actions.
- Oversee issue and remediation tracking, monitoring, and escalation, including documentation in governance, risk, and compliance systems.
- Develop executive-level dashboards and reporting on compliance risks, key metrics, issue remediation, and emerging concerns.
- Provide Second Line oversight and guidance to business owners on preventive measures and corrective actions.
- Partner with business owners, Enterprise Compliance, Risk Operations, and vendor teams to identify, assess, track, escalate, and report compliance risks and issues.
- Oversee implementation of new CMS and Medicaid contract requirements across operational areas in HPS.
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