Associate Director, Risk Management- Humana Clinical Pharmacy Review

Humana

3d • $126,300 - $173,700 • Remote

About The Position

The Associate Director, Risk Management identifies and analyzes potential sources of loss to minimize risk. The Associate Director, Risk Management requires a solid understanding of how organization capabilities interrelate across department(s). The Associate Director, Risk Management estimates the potential financial consequences of an occurring loss. Develops and implements controls and cost-effective approaches to minimize the organization's risks. Assesses and communicates information regarding business risks with functions across the organization. Decisions are typically related to identifying and resolving complex technical and operational problems within department(s), and could lead multiple managers or highly specialized professional associates. As Associate Director, Risk Management – HCPR, you supervise a team and work with HCPR Operations to ensure operational processes are compliant with appropriate regulations and required reporting accurately reflects operations.

Requirements

• Bachelor's Degree
• Experience with Prior Authorization, Compliance, or Risk Management
• 2 or more years of people management experience
• Must be passionate about contributing to an organization focused on continuously improving consumer experiences

Responsibilities

• Drive the culture of compliance within HCPR to maintain audit ready everyday status
• Coordinate, assign, train and ensure competency in all audit related functions – data production, speaking, driving and research
• Oversee universe generation and metric reporting for all lines of business
• Facilitate risk assessment discussions related to compliance issues and/or new guidance implementation
• Support Medicaid prior authorization work – both run the business and new state implementations – from a compliance perspective
• Develop departmental strategy as it relates to new initiatives or guidance
• Actively reviews change requests for IT systems for compliance to regulations and impacts to existing processes
• Create, review and/or analyze processes, documentation and data to identify any gaps specifically around compliance with regulatory requirements
• Provide support around Quality Events from a compliance/risk perspective
• Create executive-level dashboards to summarize compliance risks and key performance indicators
• Build and maintain key working relationships across Humana related to your assigned functional area
• Facilitate risk assessment discussions related to compliance issues and/or new guidance implementation
• Responsible for team performance, development, and coaching
• Develops and executes associate engagement planning

Benefits

• medical
• dental
• 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

What This Job Offers

• Job Type: Full-time
• Career Level: Manager