Risk Management Professional

Become a part of our caring community and help us put health first

The Risk Management Professional 2 identifies and analyzes potential sources of loss to minimize risk. The Risk Management Professional 2 work assignments are varied and frequently require interpretation and independent determination of the appropriate courses of action. Makes decisions regarding own work methods, occasionally in ambiguous situations, and requires minimal direction and receives guidance where needed. Follows established guidelines and procedures.

As a Risk Management Professional 2 — HCPR Compliance, you will work with HCPR Operations to ensure operational processes are complaint with appropriate regulations and report data that accurately reflects operations. In this role you will:

• Develop data universe generation guidelines (DUGG) for audit universes by interpreting protocols/guidance and reconciling it to processes/system logic
• Produce monthly universes and metrics reporting
• Review and analyze processes, documentation and data to identify any gaps specifically around compliance with regulatory requirements
• Contribute to executive-level dashboards to summarize compliance risks and key performance indicators
• Analyze data to identify root causes of noncompliance; work with HCPR Operational teams to develop and implement corrective action
• Develop and maintain key working relationships across Humana related to your assigned functional area
• Recognize trends in non-compliant data and conduct trainings with appropriate operations staff to correct
• Provide guidance on process updates and policy documents from a compliance perspective
• Participate in risk assessment discussions related to compliance issues and/or new guidance implementation
• Participate in audit presentation internally and externally

• Minimum of 2 years in either compliance/risk management, pharmacy
• Healthcare related process improvement, project management skills
• Strong organization and attention to detail
• Analytical skills using platforms such as Power BI, SQL, MS Office Suite, Excel
• Strong interpersonal skills and the ability to effectively communicate, both written and verbally.
• Detail oriented with the ability to multi-task and meet deadlines with minimal supervision.
• General understanding of Medicare Part D & CMS guidelines
• Must be passionate about contributing to an organization focused on continuously improving consumer experiences

• Bachelor’s degree
• Experience creating queries/pulling reports in SQL
• Risk management and compliance experience
• Audit experience

Workstyle: Remote work at Home

Location: U.S.

Schedule: Typically, Monday through Friday 8:00 AM – 5:00 PM Eastern

Travel: None

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 required; 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.

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…