Senior Risk Management Professional

📋 Description

• • As a Senior Risk Management Professional at Humana Inc., you will play a pivotal role in safeguarding the organization by proactively identifying, analyzing, and mitigating potential sources of loss. This remote position, based in Kentucky, offers a unique opportunity to leverage your expertise in risk assessment and compliance within the dynamic Humana Pharmacy Solutions organization.
• • Your primary responsibility will be to collaborate closely with business owners to ensure robust compliance frameworks are in place and effectively maintained. You will be an integral part of the Risk Operations and Humana Pharmacy Solutions teams, working diligently to identify, meticulously track, efficiently resolve, and clearly report on compliance issues and emerging risks specific to the pharmacy sector.
• • A key aspect of this role involves supporting both the Medicaid and commercial pharmacy lines of business. This includes spearheading the resolution of compliance issues, preparing for and managing audits, ensuring readiness for regulatory reviews, and effectively communicating any necessary changes or updates to the broader team.
• • You will be tasked with thoroughly reviewing and interpreting complex Medicaid contract language, translating these requirements into actionable implementation plans and maintaining comprehensive process documentation. This ensures that Humana remains compliant with all contractual obligations and regulatory mandates.
• • A significant part of your contribution will involve the proactive identification of potential risk areas within the pharmacy operations. Based on these findings, you will develop targeted audit and review recommendations, and subsequently analyze the output of these reviews to drive continuous improvement and risk reduction strategies.
• • To facilitate informed decision-making at the executive level, you will be responsible for developing and maintaining sophisticated, executive-level dashboards. These dashboards will provide clear and concise summaries of compliance risks, highlight key performance indicators (KPIs), and offer actionable insights into the overall risk posture of the pharmacy solutions.
• • This role demands a strategic approach to partnership building. You will cultivate and maintain strong, collaborative relationships across various departments and stakeholders within Humana, fostering a shared understanding and commitment to risk management and compliance.
• • You will be instrumental in developing and implementing risk management strategies that align with Humana's overarching business objectives, ensuring that risk is managed effectively without hindering innovation or operational efficiency.
• • The position requires a deep understanding of regulatory landscapes impacting the healthcare and pharmacy industries, including but not limited to HIPAA, CMS regulations, and state-specific pharmacy laws.
• • You will contribute to the development and refinement of internal controls and policies to address identified risks and ensure adherence to best practices in risk management.
• • This role offers the chance to make a tangible impact on the well-being of millions of individuals by ensuring the integrity and compliance of Humana's pharmacy services, thereby contributing to the company's mission of putting health first.
• • You will be expected to stay abreast of industry trends and emerging risks in risk management and pharmacy operations, bringing innovative solutions and perspectives to the team.
• • The Senior Risk Management Professional will also be involved in training and mentoring junior team members, sharing knowledge and best practices in risk management and compliance.
• • This position requires a high degree of analytical thinking, problem-solving skills, and the ability to communicate complex information clearly and concisely to diverse audiences, from operational teams to senior leadership.
• • Ultimately, your work will directly contribute to Humana's commitment to providing high-quality, compliant, and accessible healthcare services, reinforcing its position as a leader in the industry.