Associate Director, Risk Management- Humana Clinical Pharmacy Review

** Become a part of our caring community*
* 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. In this role you will:

+ 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

** Use your skills to make an impact*
* ** Required Qualifications*
* + 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

** Additional Information*
* SSN Alert :
Humana values personal identity protection. Please be aware that applicants may be asked to provide their Social Security Number, if it is not already on file. When required, an email will be sent from  with instructions on how to add the information into your official application on Humana's secure website.

As part of our hiring process for this opportunity, we will be using an interviewing technology called Hire Vue to enhance our hiring and decision-making ability. Hire Vue 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.

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 recommended; wireless, wired cable or DSL connection is suggested

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

Employees who live and work from Home in the state of California, Illinois, Montana, or South Dakota will be provided a bi-weekly payment for their internet expense. Humana will provide Home or Hybrid Home/Office employees with telephone equipment appropriate to meet the business requirements for their position/job. Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information.

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…