Senior Risk Management Professional
- $86,300–$118,700 per year
- Remote
- Full Time
About the role
This position is listed on behalf of a partner company, who manages all applications and next steps. Our partner is looking for a Senior Risk Management Professional based in the United States.
In this role, you will support the assessment, coordination, and implementation of regulatory requirements within the Medicare and Pharmacy Benefit Management (PBM) sectors. You will play a key role in ensuring regulatory guidance is translated into effective business processes, appropriate controls, and documented implementation activities. Working closely with cross-functional teams across compliance, pharmacy operations, legal, regulatory, and risk management, you will help maintain operational readiness and regulatory compliance. You will assess implementation progress, identify potential gaps, and coordinate corrective actions to mitigate business risks. This position offers the opportunity to contribute to critical healthcare compliance initiatives in a dynamic, highly regulated environment. It is a fully remote opportunity requiring strong analytical skills, attention to detail, and effective stakeholder collaboration.
Accountabilities:
Coordinate the intake, assessment, and implementation of Medicare and PBM pharmacy regulatory guidance, ensuring requirements are accurately understood and addressed within established deadlines.
Work closely with relevant stakeholders to organize implementation activities, required responses, supporting evidence, documentation, and operational controls.
Review regulatory and business requirements to identify potential implementation gaps, assess associated risks, and determine appropriate follow-up actions.
Validate high-priority and major regulatory implementations to confirm completeness, accuracy, readiness, and alignment with applicable requirements.
Manage Risk Acceptances for identified implementation gaps or residual risks, ensuring decisions are appropriately reviewed, documented, and maintained.
Coordinate cross-functional initiatives involving pharmacy and PBM operations, Medicare, compliance, regulatory, legal, and risk management teams.
Monitor multiple concurrent regulatory implementations, tracking milestones, deliverables, dependencies, and implementation progress.
Identify emerging risks, operational barriers, and compliance issues, escalating concerns and facilitating resolution with the appropriate stakeholders.
Maintain accurate records of implementation decisions, validation activities, supporting evidence, controls, and risk-related documentation.
Support continuous improvement of regulatory implementation processes, risk management practices, and governance activities.
Adapt implementation priorities and execution plans in response to changing regulatory guidance, business requirements, and deadlines.
Requirements:
Bachelor's degree or at least 3 years of relevant professional experience in healthcare, regulatory compliance, risk management, pharmacy or PBM operations, Medicare, or a related field.
Experience reviewing, interpreting, assessing, or implementing regulatory requirements, compliance standards, or business policies.
Demonstrated ability to coordinate cross-functional projects and initiatives involving multiple stakeholders and business functions.
Strong organizational and project coordination skills, with the ability to manage several concurrent priorities and time-sensitive deliverables.
Excellent analytical and problem-solving abilities, including identifying implementation gaps, evaluating risks, and determining when escalation is necessary.
Strong written and verbal communication skills, with the ability to communicate effectively across operational, technical, and leadership teams.
Proficiency in Microsoft Office applications, particularly Excel, Outlook, Teams, and SharePoint.
High attention to detail and the ability to maintain accurate, complete, and well-organized implementation and compliance documentation.
Ability to work independently while building effective relationships across multiple business areas in a complex, highly regulated environment.
Comfort working in a changing regulatory landscape where priorities, requirements, and implementation timelines may evolve quickly.
Preferred qualifications:
Experience with Medicare Part D, Centers for Medicare & Medicaid Services (CMS) guidance, or broader Medicare regulatory requirements.
Familiarity with Pharmacy Benefit Management (PBM) operations and pharmacy-related regulatory and compliance requirements.
Previous experience working within a health plan, pharmacy, PBM organization, or another highly regulated healthcare environment.
Experience collecting, reviewing, validating, and maintaining regulatory implementation evidence, controls, and supporting documentation.
Background in regulatory implementation oversight, validation, or compliance monitoring.
Familiarity with Risk Acceptances, issue management, corrective action plans, and formal risk management processes.
Experience using regulatory, compliance, governance, risk management, or implementation tracking platforms.
Ability to maintain a dedicated and secure remote workspace to protect confidential information and comply with HIPAA and member privacy requirements.
Reliable home internet connection with minimum download speeds of 25 Mbps and upload speeds of 10 Mbps.
Willingness to travel occasionally for office meetings or training sessions, if required.
Benefits:
Competitive annual salary ranging from $86,300 to $118,700, depending on qualifications, experience, skills, and geographic location.
Eligibility for a performance-based bonus incentive plan.
Fully remote working arrangement within the United States.
Comprehensive medical, dental, and vision insurance.
401(k) retirement savings plan.
Paid time off, company holidays, and personal holidays.
Paid parental and caregiver leave.
Short-term and long-term disability coverage.
Life insurance and additional employee protection benefits.
Access to wellness programs and resources supporting employees' personal and professional well-being.
Opportunity to contribute to meaningful healthcare initiatives while developing expertise in regulatory compliance and enterprise risk management.
Collaborative environment offering exposure to multiple healthcare, pharmacy, compliance, and regulatory functions.