Associate Director, Risk Management – Clinical Pharmacy Review

This is a fully remote position, open to applicants in United States.

📋 Description

• Identify and evaluate potential loss sources to mitigate risk.

• Estimate the financial impact of potential losses.

• Create and implement controls and cost-effective strategies to reduce organizational risks.

• Assess and convey business-risk information across various organizational functions.

• Supervise a team and collaborate with HCPR Operations to ensure compliance with operational processes.

• Foster a culture of compliance and uphold audit-ready status.

• Coordinate, delegate, train, and ensure proficiency in audit-related tasks.

• Oversee the generation of reports and metrics for all business lines.

• Facilitate discussions on risk assessment concerning compliance issues and new guidelines.

• Support Medicaid prior authorization operations and assist with new state implementations from a compliance viewpoint.

• Formulate departmental strategies for new initiatives and guidance.

• Review IT system change requests for regulatory compliance and their impact on processes.

• Analyze processes, documentation, and data to identify gaps in regulatory compliance.

• Support Quality Events from a compliance and risk management perspective.

• Create executive-level dashboards that summarize compliance risks and key performance indicators.

• Build and sustain collaborative relationships across Humana.

• Manage team performance, development, coaching, and associate engagement initiatives.

⛳️ Requirements

• Bachelor's Degree.

• Experience in Prior Authorization, Compliance, or Risk Management.

• A minimum of 2 years of experience in people management.

• A strong commitment to enhancing consumer experiences within an organization.

• Minimum download internet speed of 25 Mbps and upload speed of 10 Mbps for remote work.

• Ability to work in a dedicated space free from interruptions to protect member PHI / HIPAA information.

• Satellite, cellular, or microwave internet connections require leadership approval.

• Capability to procure or obtain a suitable internet service upgrade if necessitated by Humana.

🏝️ Benefits

• Bonus incentive plan based on individual and/or company performance.

• Medical, dental, and vision insurance.

• 401(k) retirement savings plan.

• Paid time off.

• Company-recognized holidays.

• Personal holidays.

• Paid parental leave.

• Paid caregiver leave.

• Short-term disability coverage.

• Long-term disability coverage.

• Life insurance.

• Internet expense reimbursement for employees working from home in California, Illinois, Montana, or South Dakota.

• Telephone equipment provided for Home or Hybrid Home/Office employees.

• Flexible remote work arrangements.

• Occasional travel to Humana offices for training or meetings.