Humana

Senior Risk Management Professional

Humana  •  $86k - $119k/yr  •  Kentucky (Remote)  •  2 days ago
Apply
AI can make mistakes so check important info. Chat history is never stored.

Job Description

Become a part of our caring community

The Senior Risk Management Professional identifies and analyzes potential sources of loss to minimize risk. The Senior Risk Management Professional work assignments involve moderately complex to complex issues where the analysis of situations or data requires an in-depth evaluation of variable factors.

The Senior Risk Management Professional plays a critical role in supporting compliance and risk management activities across Humana Pharmacy Solutions. This position partners closely with business owners, Risk Operations, and cross-functional teams to identify, assess, track, and resolve compliance issues and risks across both Medicaid and Commercial pharmacy lines of business.

This role requires a strategic thinker with strong analytical, audit, and communication skills to ensure regulatory compliance, operational readiness, and continuous process improvement.

Key Responsibilities

  • Collaborate with business leaders and operational teams to support compliance initiatives and risk mitigation strategies
  • Identify, assess, track, and resolve compliance issues and risks within Humana Pharmacy Solutions
  • Support audit activities, including preparation, execution, and remediation planning
  • Lead and contribute to audit readiness efforts across Medicaid and Commercial pharmacy operations
  • Interpret Medicaid contract language and translate requirements into operational processes and documentation
  • Develop, maintain, and enhance process documentation related to pharmacy implementation and compliance requirements
  • Proactively identify risk areas and develop audit/review recommendations
  • Analyze audit findings and ensure appropriate follow-up actions are executed
  • Design and maintain executive-level dashboards to track compliance risks, performance metrics, and key performance indicators (KPIs)
  • Communicate regulatory or compliance changes to broader teams and ensure appropriate implementation


Use your skills to make an impact

Required Qualifications

  • Bachelor’s degree in Healthcare Administration, Business, Finance, Risk Management, or a related field, OR equivalent experience.
  • 3–5+ years of experience in risk management, compliance, audit, or regulatory affairs within healthcare, pharmacy, or managed care
  • Experience supporting Medicaid and/or Commercial lines of business
  • Strong knowledge of compliance frameworks, audit processes, and risk management methodologies
  • Demonstrated experience interpreting regulatory or contract language (e.g., Medicaid contracts)
  • Proven ability to analyze complex data and translate findings into actionable insights
  • Experience developing reports, dashboards, and executive summaries
  • Excellent written and verbal communication skills, including the ability to present to senior leadership
  • Strong organizational skills with the ability to manage multiple priorities in a fast-paced environment
  • Proficiency in Microsoft Office Suite (Excel, PowerPoint, Word)

Preferred Qualifications

  • Experience within pharmacy operations, PBM (Pharmacy Benefit Management), or healthcare compliance
  • Knowledge of CMS, Medicaid, and pharmacy regulatory requirements
  • Experience supporting audit readiness, remediation, and regulatory submissions
  • Familiarity with risk management tools and systems (e.g., GRC platforms)
  • Advanced data analysis and reporting skills (e.g., Power BI, Tableau, or similar tools)
  • Experience designing and maintaining KPI dashboards for executive leadership
  • Certification in risk or compliance (e.g., CISA, CRCM, CHC, CRMP) or related credential
  • Strong stakeholder management skills with demonstrated ability to influence without authority
  • Experience working in a matrixed organization

Additional Information

Interview Format

As part of our hiring process for this opportunity, we will be using an interviewing technology called HireVue to enhance our hiring and decision-making ability. HireVue allows us to quickly connect and gain valuable information from you pertaining to your relevant skills and experience at a time that is best for your schedule.

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.
Satellite, cellular and microwave connection can be used only if approved by leadership.

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

The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc.$86,300 - $118,700 per yearThis job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance.

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, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.


About us

About Humana: Humana Inc. (NYSE: HUM) is a leading U.S. healthcare company. Through our Humana insurance services and our CenterWell healthcare services, we make it easier for the millions of people we serve to achieve their best health – delivering the care and service they need, when they need it. These efforts are leading to a better quality of life for people with Medicare and Medicaid, families, individuals, military service personnel, and communities at large. Learn more about what we offer at Humana.com and at CenterWell.com.


Equal Opportunity Employer

It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status. It is also the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and VEVRAA, to employ and to advance in employment individuals with disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment.

Humana

About Humana

Humana will never ask, nor require a candidate to provide money for work equipment and network access during the application process. If you become aware of any instances where you as a candidate are asked to provide information and do not believe it is a legitimate request from Humana or affiliate, please contact yourcareer@humana.com to validate the request

At Humana, our cultural foundation is aligned to helping members achieve their best health by delivering personalized, simplified, whole-person healthcare experiences. Recognizing healthcare needs continue to evolve for each person, for each family and for each community, Humana continuously creates innovative solutions and resources that help people live their healthiest lives on their terms –when and where they need it. Our employees are at the heart of making this happen and that’s why we are dedicated to building an organization of dynamic talent whose experience and passion center on putting the customer first.

Industry
Finance & Insurance
Company Size
10,000+ employees
Headquarters
Louisville, Kentucky
Year Founded
Unknown
Social Media