Senior Risk Management Professional

Job not on LinkedIn

🔥 1 minute ago

🇺🇸 United States – Remote

💵 $86.3k - $118.7k / year

⏰ Full Time

🟠 Senior

🔒 Insurance

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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

• Support effective intake, assessment, and implementation of Medicare and PBM pharmacy regulatory guidance • Coordinate required responses, evidence, controls, and implementation activities • Validate high-ranked and major implementations for completeness and readiness • Manage Risk Acceptances for identified gaps or residual risks • Partner with key stakeholders to ensure guidance is implemented accurately and documented appropriately • Ensure implementations are completed within required timelines • Coordinate cross-functional regulatory implementations across pharmacy/PBM operations, Medicare, compliance, regulatory, legal, risk management, and other impacted business areas • Identify implementation gaps, escalate risks or barriers, and facilitate resolution with stakeholders • Maintain implementation decisions, supporting evidence, controls, validations, and Risk Acceptances

🎯 Requirements

• Bachelor’s degree OR 3+ years of experience in healthcare, regulatory compliance, risk management, pharmacy/PBM operations, Medicare, or a related field • Experience reviewing, assessing, or implementing regulatory, compliance, or business requirements • Ability to coordinate cross-functional implementations, projects, or initiatives involving multiple stakeholders • Ability to manage multiple priorities and time-sensitive deliverables simultaneously • Strong analytical and problem-solving skills, including identifying gaps, risks, and issues requiring follow-up or escalation • Strong written and verbal communication skills • Proficiency with Microsoft Office applications, including Excel, Outlook, Teams, and SharePoint • Preferred: Experience with Medicare Part D, CMS guidance, or Medicare regulatory requirements • Preferred: Experience with PBM or pharmacy regulatory/compliance requirements • Preferred: Experience in a health plan, PBM, pharmacy, or other highly regulated healthcare environment • Preferred: Experience collecting, reviewing, and maintaining regulatory implementation evidence, controls, and supporting documentation • Preferred: Experience validating or overseeing regulatory implementations • Preferred: Experience with Risk Acceptances, issue management, corrective actions, or other formal risk-management processes • Preferred: Experience using regulatory, compliance, governance, risk, or implementation tracking systems • Ability to work independently and collaboratively across multiple business areas in a highly regulated environment • Ability to manage multiple concurrent regulatory implementations with varying complexity, priority, and timelines • Comfort identifying implementation gaps, escalating risks or barriers, and facilitating resolution • Strong attention to detail • Comfort working in an environment where regulatory requirements, priorities, and timelines may change quickly • Minimum home internet speed of 25 Mbps download and 10 Mbps upload for home or hybrid employees • Dedicated workspace without ongoing interruptions to protect member PHI/HIPAA information

🏖️ 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 and personal holidays • Paid parental and caregiver leave • Short-term and long-term disability • Life insurance • Occasional travel to Humana offices for training or meetings

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