Associate Director, Risk Management – Clinical Pharmacy Review

Humana

. Identify and analyze potential sources of loss to minimize risk .

Posted 10/13/2026full-timeRemote • United StatesSenior💰 $126,300 - $173,700 per yearWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates expertise in Risk Management, Compliance, and Prior Authorization processes while effectively leading teams to ensure operational compliance and enhance organizational strategies. Proficient in analyzing regulatory gaps and developing cost-effective controls to minimize risks and improve consumer experiences.

Highest-signal resume keywords

Risk ManagementCompliancePrior AuthorizationPeople ManagementRegulatory Compliance

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Risk AnalysisFinancial Consequence EstimationAudit-Related FunctionsMetric ReportingProcess Documentation ReviewQuality Event SupportExecutive-Level Dashboard CreationRegulatory Compliance Gap AnalysisDepartmental Strategy DevelopmentOperational Process Compliance

Soft Skills

Team Performance ManagementCoachingCommunicationRelationship BuildingEngagement Planning

Certifications & Qualifications

Bachelor's Degree

Industry Keywords

HCPR OperationsConsumer Experience ImprovementAudit-Ready StatusCompliance CultureMedicaid Operations

About the role

Key responsibilities & impact

Identify and analyze potential sources of loss to minimize risk
Estimate potential financial consequences of losses
Develop and implement controls and cost-effective approaches to minimize organizational risks
Assess and communicate business-risk information across organizational functions
Supervise a team and work with HCPR Operations to ensure operational processes comply with regulations
Drive a culture of compliance and maintain audit-ready status
Coordinate, assign, train, and ensure competency in audit-related functions
Oversee universe generation and metric reporting for all lines of business
Facilitate risk-assessment discussions regarding compliance issues and new guidance
Support Medicaid prior authorization operations and new state implementations from a compliance perspective
Develop departmental strategy for new initiatives and guidance
Review IT-system change requests for regulatory compliance and process impacts
Analyze processes, documentation, and data to identify regulatory compliance gaps
Support Quality Events from a compliance and risk perspective
Create executive-level dashboards summarizing compliance risks and key performance indicators
Build and maintain working relationships across Humana
Manage team performance, development, coaching, and associate engagement planning

Requirements

What you’ll need

Bachelor's Degree
Experience with Prior Authorization, Compliance, or Risk Management
2 or more years of people management experience
Passion for contributing to an organization focused on continuously improving consumer experiences
Minimum download internet speed of 25 Mbps and upload speed of 10 Mbps for home work
Ability to work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information
Satellite, cellular, or microwave internet connection requires leadership approval
Ability to provide or obtain a suitable internet service upgrade if required by Humana

Benefits

Comp & perks

Bonus incentive plan based on company and/or individual performance
Medical, dental and vision benefits
401(k) retirement savings plan
Paid time off
Company holidays
Personal holidays
Paid parental leave
Paid caregiver leave
Short-term disability
Long-term disability
Life insurance
Internet expense payment for employees who live and work from home in California, Illinois, Montana, or South Dakota
Telephone equipment for Home or Hybrid Home/Office employees
Remote work arrangement
Occasional travel to Humana offices for training or meetings