This description is a summary of our understanding of the job description. Click on 'Apply' button to find out more. Role Description EmpiRx Health is seeking a highly skilled and experienced Risk Manager. In this critical role, the Risk Manager plays a key role in supporting and ensuring the achievement of enterprise goals. The Risk Manager works closely with key departments to proactively identify and address any new or potential overlapping financial, clinical, and or client retention risks. The Risk Manager is responsible for tracking the interdepartmental Clinical, Financial, and Client Retention risks, identifying opportunities for alignment, overseeing the execution of strategies, and reporting on performance to leadership stakeholders. The Risk Manager is part of the Business Intelligence and Analytics organization and also participates as an SME for new products and services being deployed. Key Responsibilities: - Risk Management & Strategic Projects: - Analyze and execute the compilation of, development of, and reporting of strategic project developments that involve interdepartmental risks. - Conduct comparative analyses for a client or Book of Business across different time frames and track key statistics for priority clients from several focus areas such as clinical utilization or financial performance. - Identify, analyze, and share conclusions based on findings of spend, utilization, and PMPM trends across the Book of Business as well as client level for various audiences (leadership, client-friendly, internal use by teams, etc.). - Collaborate with various stakeholders on new and ongoing monitoring, target setting, renewal or product strategies and solutions. - Perform ROI analysis, performance monitoring, and identification of enhancements of clinical solutions for external and internal partners. - Delivery: - Proficiently utilize internal and third-party platforms and reporting tools needed (e.g., Databricks, Power BI, DOMO). - Effectively utilize project management tools (e.g., Azure DevOps, JIRA, etc.) to communicate and track requests with other internal teammates. - Assist with ad-hoc projects that involve the various risk teams. - Follow all defined practices, processes, and procedures with inter-departmental teams such as Finance, UW, and Client Experience. - Relationship Management: - Develop and maintain strong relationships with key teams including Care Management, Client Management, and Finance. - Handle ad hoc requests from Care Management, Client Experience, and Finance teams. - Effectively support fellow peers, as needed. Qualifications - Bachelor’s degree - At least 3 years of PBM experience or at least 4 years of experience in Analytics, Business Intelligence or similar - Strong data science skills using tools like SQL, R, Python, or SAS - Advanced analytical skills, with the ability to perform complex analysis and make recommendations based on statistical inferences - Excellent critical thinking and problem-solving skills - Ability to work in a fast-paced environment - Proficient in Microsoft Office Suite - Excellent time management skills and ability to meet deadlines Requirements - Experience with analytics model development and maintenance, report development, troubleshooting, and support - Proficiency in BI tools such as Power BI or dashboard tools like Tableau, Looker, or Domo - Excellent oral, writing and presentation skills; able to develop and deliver clear, crisp, and customer-focused messages and presentations to all levels of company team members Benefits - Paid Time Off - 401(k) program - Health Insurance including Dental & Vision coverage - Student Loan Reimbursement - Health Savings Account - Employee Assistance Program Company Description EmpiRx Health is the leading clinically-driven pharmacy benefits management company. As the pioneer in value-based pharmacy care, EmpiRx Health puts its customers and members first by enabling them to take control of their pharmacy benefits, healthcare outcomes, and financial results. We place more emphasis on member care than any other PBM by focusing on health outcomes first. Our pharmacists and clinicians are at the center of everything we do, and our population health solution delivers tailored strategies for our clients. Leveraging our newly launched, AI-powered pharmacy care platform, Clinically™, EmpiRx Health’s pharmacists and client experience teams provide the highest quality pharmacy care to our clients and their members.

Become a part of our caring community and help us put health first The Director, Home Health Risk Management identifies and analyzes potential sources of risk, proactively ensuring controls and processes are in place to reduce risk. The Director, Home Health Risk Management requires an in-depth understanding of how organization capabilities interrelate across the Home Health segment. The Director of Risk Management for Home Health will be responsible for development and implementation of controls and cost-effective approaches to minimize risks to the organization as well as estimating the potential consequences of risks. Assesses and communicates information regarding business risks with functions across the organization. Their focus will be on CenterWell risk assessments, issue management, auditing and monitoring. Areas of oversight will include CenterWell Home Health, OneHome, as well as new growth initiatives. This role requires an in-depth understanding of Home Health in a Value Based Care environment and how organization capabilities interrelate across segments and with the Plan side of Humana. This individual will be responsible for assessing and communicating information regarding business risks with functions across the organization at the Vice President level. Decisions are typically related to the implementation of new/updated programs or large-scale projects for CenterWell Home Health, supporting technical/operational procedures and processes, new regulatory or compliance regulation, evaluation and implementation of key controls, drives goals and objectives, improves performance, and provides input into strategy. This individual will lead a team of 5 total associates. Use your skills to make an impact Key Responsibilities: - Focus on risk and compliance strategies for home health, telehealth, data privacy, and payor agnostic experiences. - Payor contract compliance - Oversees specialized proactive risk assessments for large financially impactful or business critical projects, business integrations as well as other risk tools such as lessons learned reviews. - Partnerships across Integrated Health, Reporting, Marketing, and operational partners to ensure compliance with: Privacy, Security, and data sharing policies, Federal & State Laws, CHAPs certification requirements, and CMS regulations as applicable - Establish an annual oversight workplan for areas of oversight (CenterWell Home Health & OneHome) - Monitor teams progression to the workplan and ensure the quality of workplan items conducted by the team - Issues management & resolution for areas of oversight, drive solutions to resolve issues - Facilitation of discussions related to risk with AVP/VP level individuals - Drive clear and open communication across the Home Health organization and key partners - Continuously improve the Risk Management processes to enhance efficiency and effectiveness and reduce overall volume of issues - Stay abreast of risk management trends and best practices within Humana and externally to incorporate better practices - Partner with leaders across CenterWell to ensure consideration of regulatory guidance, patient, financial, and associate risks in key initiatives and decisions - Facilitate conversations across Home Health leaders to drive resolution of issues and improvement of Quality - Train team on risk management processes to enable them to be successful Required Qualifications - Bachelor's Degree - 8 or more years of technical experience in the Home Health space - 5 or more years of management experience - Must be passionate about contributing to an organization focused on continuously improving consumer experiences Preferred Qualifications - Master's Degree - 5 or more years of regulatory compliance or risk management experience Additional Information: Interview Format: As part of our hiring process for this opportunity, we will be using an interviewing technology called HireVue to enhance our hiring and decision-making ability. HireVue allows us to quickly connect and gain valuable information from you pertaining to your relevant skills and experience at a time that is best for your schedule. Work at home requirements: 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. SSN Alert: 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 Humana@myworkday.com with instructions on how to add the information into your official application on Humana’s secure website. Travel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be required. Scheduled Weekly Hours 40 Pay Range The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc. $150,000 - $206,300 per year This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance. Description of Benefits Humana, Inc. and its affiliated subsidiaries (collectively, “Humana”) offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities. Application Deadline: 03-26-2026 About us About CenterWell Senior Primary Care: CenterWell Senior Primary Care provides proactive, preventive care to seniors, including wellness visits, physical exams, chronic condition management, screenings, minor injury treatment and more. Our unique care model focuses on personalized experiences, taking time to listen, learn and address the factors that impact patient well-being. Our integrated care teams, which include physicians, nurses, behavioral health specialists and more, spend up to 50 percent more time with patients, providing compassionate, personalized care that brings better health outcomes. We go beyond physical health by also addressing other factors that can impact a patient’s well-being. About CenterWell, a Humana company: CenterWell creates experiences that put patients at the center. As the nation’s largest provider of senior-focused primary care, one of the largest providers of home health services, and fourth largest pharmacy benefit manager, CenterWell is focused on whole-person health by addressing the physical, emotional and social wellness of our patients. As part of Humana Inc. (NYSE: HUM), CenterWell offers stability, industry-leading benefits, and opportunities to grow yourself and your career. We proudly employ more than 30,000 clinicians who are committed to putting health first – for our teammates, patients, communities and company. By providing flexible scheduling options, clinical certifications, leadership development programs and career coaching, we allow employees to invest in their personal and professional well-being, all from day one.​ Equal Opportunity Employer It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status. It is also the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and VEVRAA, to employ and to advance in employment individuals with disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment.

• Centralize Data Rights: Implement a codified, scalable solution to track, manage, and update data rights and usage controls across all business units and data domains. • Enable Responsible Innovation: Integrate governance frameworks into product development, analytics, and AI workflows to ensure responsible and compliant use of Inovalon’s data assets. • Audit Readiness: Maintain comprehensive documentation and audit controls to ensure the data platform is continuously prepared for internal and external regulatory audits. • Visualize Data Trends: Build automated monitoring and reporting tools that provide realtime visibility into data pipeline readiness, integrity, and freshness. • Vulnerability Management: In partnership with other teams, identify points of data vulnerability and lead the implementation of mitigation and remediation protocols. • KPI Tracking: Define, measure, and report metrics that assess the effectiveness and maturity of data governance practices • Other Responsibilities: Maintain compliance with Inovalon’s policies, procedures, and mission statement. Adhere to all confidentiality and HIPAA requirements as outlined within Inovalon’s Operating Policies and Procedures in all ways and at all times with respect to any aspect of the data handled or services rendered in the undertaking of the position. Fulfill those responsibilities and/or duties that may be reasonably provided by Inovalon for the purpose of achieving operational and financial success of the Employer.

• Support the development and implementation of clinical risk management strategies for high-cost, complex claims. • Analyze incoming cost containment referrals, evaluate clinical and claims data to identify and quantify risk, and engage effective cost containment strategies. • Act as a strategic partner to underwriting by applying evidence-based criteria and sound clinical judgment. • Develop, maintain, and manage strong relationships with internal and external clients, Third-Party Administrators (TPAs), brokers and vendors. • Ensure accurate entry, validation, and analysis of cost containment, notification, and medical underwriting data within the claims system. • Serve as a primary subject matter expert, articulating complex clinical conditions, pharmaceuticals, and risk structures to diverse audiences.