Associate Director, Risk Management – Clinical Pharmacy Review

🔥 41 minutes ago

🇺🇸 United States – Remote

💵 $126.3k - $173.7k / year

⏰ Full Time

🟠 Senior

🔒 Insurance

🦅 H1B Visa Sponsor

This company has sponsored H1B visas in the past.

👻 Ghost score 0%

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Humana

WebsiteLinkedInAll Job Openings

10,000+ employees

Founded 1961

🏥 Healthcare

🛡️ Insurance

⚕️ Healthcare Insurance

Healthcare • Insurance • Healthcare Insurance

Humana is a healthcare company dedicated to making a positive impact on the health of individuals, communities, and the healthcare system as a whole. With a focus on putting health first, Humana serves a diverse range of populations, including seniors and the military, providing Medicare Advantage HMO, PPO, and PFFS plans. Humana is committed to fostering a culture of belonging and mutual respect, offering competitive and flexible benefits to ensure the financial security of its employees and their families. The company prides itself on creating an inclusive workplace where everyone has the opportunity to succeed.

📋 Description

• Identify and analyze potential sources of loss to minimize risk • Estimate potential financial consequences of losses • Develop and implement controls and cost-effective approaches to minimize organizational risks • Assess and communicate business-risk information across organizational functions • Supervise a team and work with HCPR Operations to ensure operational processes comply with regulations • Drive a culture of compliance and maintain audit-ready status • Coordinate, assign, train, and ensure competency in audit-related functions • Oversee universe generation and metric reporting for all lines of business • Facilitate risk-assessment discussions regarding compliance issues and new guidance • Support Medicaid prior authorization operations and new state implementations from a compliance perspective • Develop departmental strategy for new initiatives and guidance • Review IT-system change requests for regulatory compliance and process impacts • Analyze processes, documentation, and data to identify regulatory compliance gaps • Support Quality Events from a compliance and risk perspective • Create executive-level dashboards summarizing compliance risks and key performance indicators • Build and maintain working relationships across Humana • Manage team performance, development, coaching, and associate engagement planning

🎯 Requirements

• Bachelor's Degree • Experience with Prior Authorization, Compliance, or Risk Management • 2 or more years of people management experience • Passion for contributing to an organization focused on continuously improving consumer experiences • Minimum download internet speed of 25 Mbps and upload speed of 10 Mbps for home work • Ability to work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information • Satellite, cellular, or microwave internet connection requires leadership approval • Ability to provide or obtain a suitable internet service upgrade if required by Humana

🏖️ Benefits

• Bonus incentive plan based on company and/or individual performance • Medical, dental and vision benefits • 401(k) retirement savings plan • Paid time off • Company holidays • Personal holidays • Paid parental leave • Paid caregiver leave • Short-term disability • Long-term disability • Life insurance • Internet expense payment for employees who live and work from home in California, Illinois, Montana, or South Dakota • Telephone equipment for Home or Hybrid Home/Office employees • Remote work arrangement • Occasional travel to Humana offices for training or meetings