Humana Pharmacy Risk Operations Manager (Clinical Pharmacy) in Louisville, Kentucky

Role : Pharmacy Risk Operations Manager (Clinical Pharmacy)

Assignment : Pharmacy

Location: Louisville, KY

Healthcare isn’t just about health anymore. It’s about caring for family, friends, finances, and personal life goals. It’s about living life fully. At Humana, we want to help people everywhere, including our associates, lead their best lives. We support our associates to be happier, healthier, and more productive in their professional and personal lives. We encourage our people to build relationships that inspire, support, and challenge them.

We promote lifelong well-being by giving our associates fresh perspective, new insights, and exciting opportunities to grow their careers. At Humana, we’re seeking innovative people who want to make positive changes in their lives, the lives of our members, and the healthcare industry as a whole.

Assignment Capsule

The Pharmacy Risk Operations Manager contributes to the success of Humana’s business strategy by supporting risk and compliance initiatives across Pharmacy Operations teams within the Healthcare Services organization. Specifically, this Manager and associated team will be aligned with the Clinical Pharmacy areas. As the Pharmacy Risk Operations Manager, you and your team will be responsible for identifying operational and compliance risks, evaluating internal and external audit results, researching new/emerging regulatory guidance, supporting and evaluating implementation of this guidance, ensuring remediation plans are implemented for issues identified and performing ongoing monitoring and oversight.

· Provide assurance around the effectiveness and efficiency of Healthcare Services compliance and operational processes.

· Perform targeted reviews of processes, documentation, metrics, and data sets to identify operational and compliance risks/gaps; develop and oversee implementation of remediation activities.

· Identify and document internal controls; develop strategies for periodic validation

· Work with operational leaders to ensure alignment between systems, internal/external reporting, operational processes, and monitoring and oversight procedures.

· Report, verbally and in written format, on project status and results.

· Provide recommendations to drive change and follow-up to ensure plans are implemented timely and sufficiently.

· Follow-up on issues reported to ensure action plans are appropriate to mitigate the risk and drive to closure.

· Support internal and external audits as needed in coordination with the Pharmacy Risk Operations Program Manager: Review supporting documentation submissions, communicate audit findings to business owners, and work with impacted parties to implement remediation plans for issues identified.

· Work collaboratively with other oversight groups including Regulatory Compliance and Internal Audit.

Role Essentials

  • Bachelor’s degree in Business, Pharmacy, or a related field or equivalent experience
  • 5 years of audit or process consulting experience
  • Knowledge of regulations governing the health care industry (Medicare, Medicaid, Commercial)

    · Ability to work in a self-directed manner on multiple projects concurrently

    · Proficiency in Microsoft Word, Excel, PowerPoint & Outlook

    Role Desirables

  • Certifications such as CPA, CIA, CISA, CISSP, PMP

  • Advanced degree preferred
  • Experience leading people
  • Knowledge of Humana’s internal policies and procedures
  • Project management/process management experience

    Reporting Relationships:

    You will report to the Pharmacy Risk Operations Director. This area is under the leadership of the Segment President, Healthcare Services.

    #HCSRenewal

Title: Pharmacy Risk Operations Manager (Clinical Pharmacy)

Location: KY-Louisville

Requisition ID: 181374

Humana Inc., headquartered in Louisville, Ky., is a leading health care company that offers a wide range of insurance products and health and wellness services that incorporate an integrated approach to lifelong well-being. By leveraging the strengths of its core businesses, Humana believes it can better explore opportunities for existing and emerging adjacencies in health care that can further enhance wellness opportunities for the millions of people across the nation with whom the company has relationships.

Humana complies with all applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex. We also provide free language interpreter services. See our full accessibility rights information and language options.