Senior Risk Management Professional

The Senior Risk Management Professional supports the effective intake, assessment, and implementation of Medicare and PBM pharmacy regulatory guidance.

Partners with key stakeholders to promote timely implementation, appropriate risk management, and ongoing compliance with applicable requirements.

The Senior Risk Management Professional supports the intake and implementation of Medicare and PBM pharmacy guidance, including coordination of required responses, evidence, controls, and implementation activities.

Validates high-ranked and major implementations for completeness and readiness and manages Risk Acceptances for identified gaps or residual risks.

Partners with key stakeholders to ensure guidance is implemented accurately, documented appropriately, and completed within required timelines.

Required Qualifications

• 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.
• Demonstrated 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 the ability to identify 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 Qualifications

• Experience with Medicare Part D, CMS guidance, or Medicare regulatory requirements.
• Experience with PBM or pharmacy regulatory/compliance requirements.
• Experience working within a health plan, PBM, pharmacy, or other highly regulated healthcare environment.
• Experience collecting, reviewing, and maintaining regulatory implementation evidence, controls, and supporting documentation.
• Experience performing validation or oversight of regulatory implementations.
• Experience with Risk Acceptances, issue management, corrective actions, or other formal risk-management processes.
• Experience using regulatory, compliance, governance, risk, or implementation tracking systems.

Additional Information

• This position requires the ability to work independently and collaboratively across multiple business areas in a highly regulated environment.
• The role requires effective management of multiple concurrent regulatory implementations with varying levels of complexity, priority, and implementation timelines.
• The individual must be comfortable identifying implementation gaps, escalating risks or barriers, and facilitating resolution with appropriate stakeholders.
• Strong attention to detail is required to ensure implementation decisions, supporting evidence, controls, validations, and Risk Acceptances are appropriately documented and maintained.
• The position involves regular collaboration with partners across pharmacy/PBM operations, Medicare, compliance, regulatory, legal, risk management, and other impacted business areas, as applicable.
• The individual should be comfortable working in an environment where regulatory requirements, priorities, and implementation timelines may change quickly.

Work at Home Requirements

• To ensure Home or Hybrid Home/Office employees’ ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office employees must meet the following criteria: At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is required; wireless, wired cable or DSL connection is suggested.
• In certain roles, the minimum recommended internet speed required by Humana may not be sufficient for business needs.
• Humana reserves the right to require associates to upgrade their internet service if necessary.
• Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information.

Travel

• While this is a remote position, occasional travel to Humana's offices for training or meetings may be required.

Scheduled Weekly Hours

• 40

Pay Range

• $86,300 - $118,700 per year

Description of Benefits

• Humana, Inc. and its affiliated subsidiaries (collectively, “Humana”) offers competitive benefits that support whole-person well-being.
• Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work.
• Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.