HPS Growth Compliance amp Risk Management Pharmacy Operations Lead

Profile

Job Information
Humana
HPS Growth Compliance & Risk Management Pharmacy Operations Lead
in
San Antonio
Texas
Description
The Channel Development Lead defines the sales product strategy for single or multiple lines of business targeting specific markets and/or business segments. The Channel Development Lead works on problems of diverse scope and complexity ranging from moderate to substantial.
Responsibilities
Location:
Remote
The Compliance & Risk Management Pharmacy Operations Lead contributes to the success of Humana's business strategy by supporting risk and compliance initiatives across Pharmacy Operations teams. This Lead will be aligned with the Pharmacy Integration Team & support initiatives across all Pharmacy Growth channels. As the Compliance & Risk Management Pharmacy Operations Lead, you 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 and ensuring remediation plans are implemented for issues identified. In this role you will:
Complete risk assessments and maintain documentation related to risks of initiatives, projects, and communication/rollout plan
Interface with legal, presenting initiatives and overall picture of Humana Pharmacy strategies
Coordinating a regular meeting cadence with Legal and appropriate stakeholders to ensure timely & compliant execution of growth initiatives
Drive prioritization of legal evaluation of growth strategies and initiatives
Provide assurance around the effectiveness and efficiency of HPS 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 key 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
Provide recommendations to drive change and follow-up to ensure plans are implemented timely and sufficiently
Facilitate 1/1 Readiness and Go Live activities to ensure compliance, in conjunction with a project manager
Work collaboratively with other oversight groups including Regulatory Compliance and Internal Audit
Required Qualifications
Bachelor's degree in Business, Pharmacy, or any field
7 or more years of audit, pharmacy and/or process consulting experience
Knowledge of regulations governing the health care industry
Ability to work in a self-directed manner on multiple projects concurrently
Proficiency in Microsoft Word, Excel, PowerPoint & Outlook
Ability to present to executive level individuals
Strong communication skills both written and verbal
Desired Qualifications
Pharmacy operations experience
Certifications such as CPA, CIA, CISA, CISSP, PMP
Medicare, Medicaid and/or Commercial
Advanced degree preferred
Knowledge of Humana's internal policies and procedures
Project management/process management experience
Additional Information
You will report to the Pharmacy Integration Market VP. This area is under the leadership of the VP of Pharmacy Growth Strategy.
For this job, associates are required to be fully COVID vaccinated or undergo weekly COVID testing and wear a face covering while at work. The weekly testing will need to be done through an approved Humana vendor, and unvaccinated associates should follow all social distancing and masking protocols if they are required to come into a Humana facility or work outside of their home. We are a healthcare company committed to putting health and safety first for our members, patients, associates, and the communities we serve.
If progressed to offer, you will be required to:
Provide proof of full vaccination OR
Commit to weekly testing, following all CDC protocols, OR
Provide documentation for a medical or religious exemption consideration.
This policy will not supersede state or local laws. Requests for these exemptions should be submitted at least 2 weeks prior to your scheduled first day of work. ​​​​​​​
Scheduled Weekly Hours
40

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