Compliance Lead

Requirements

• Serves as dedicated Regulatory Compliance Officer for Michigan Medicaid contract.
• Builds relationships with market leadership teams and external regulators.
• Provides ongoing oversight of Medicaid operations from readiness review through contract duration to ensure full compliance and minimize risk for the Enterprise.
• Performs risk assessments, develops and implements annual regulatory compliance auditing and monitoring work plans, oversees corrective action plans and documents remediation activities.
• Interprets and defines state and federal regulatory and contract requirements for Humana Departments and/or external business partners and provides ongoing guidance.
• Reviews and analyzes market documents and data to identify what can be used to evidence meeting regulatory standards.
• Participates in external audits to review document submissions, prepare presenters, and coordinate responses for regulators, as necessary.
• Works across Humana operational units and product lines to enhance compliance data analytics and operational improvement efforts.
• Coordinates and manages a standard set of data relating to regulatory standards and reports compliance issues to senior leadership and compliance oversight committees.
• Chairs the Michigan Compliance Committee per approved charter.
• Coordinates compliance related communication/interaction with outside regulators, as necessary.
• Coordinates with the Special Investigations Unit (SIU) to operate and effective fraud, waste and abuse program integrity program.

Qualifications

• Demonstrated ability to communicate with clarity, professionalism, and impact across internal and external stakeholder groups, both verbally and in writing.
• Bachelor's degree in related field.
• 3+ years of advanced experience working in a Compliance-related or managed care-related field or Medicaid.
• 3+ years of interpreting and guiding on regulations and compliance requirements governing the health care industry.
• 3 or more years analyzing and reviewing metrics related to contract compliance.

Preferred Qualifications

• Juris Doctor and/or advanced degree.
• Audit experience.
• Experience with metrics and reporting.
• Experience working with regulatory agencies, including state departments of health insurance and/or CMS.

What Makes You Successful

Demonstrated ability to communicate with clarity, professionalism, and impact across internal and external stakeholder groups, both verbally and in writing.

Bachelor's degree in related field.

3+ years of advanced experience working in a Compliance-related or managed care-related field or Medicaid.

3+ years of interpreting and guiding on regulations and compliance requirements governing the health care industry.

3 or more years analyzing and reviewing metrics related to contract compliance.

Juris Doctor and/or advanced degree.

Audit experience.

Experience with metrics and reporting.

Experience working with regulatory agencies, including state departments of health insurance and/or CMS.

Additional Information

This role is open to Kentuckian state circles based on the markets in which the candidate will support. In this role, you will have up to 25% domestic travel based on business need.

About Us

About Humana: Humana Inc. (NYSE: HUM) is a leading U.S. healthcare company. Through our Humana insurance services and our CenterWell healthcare services, we make it easier for the millions of people we serve to achieve their best health – delivering the care and service they need, when they need it. These efforts are leading to a better quality of life for people with Medicare and Medicaid, families, individuals, military service personnel, and communities at large.

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, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.