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

The Compliance Lead ensures compliance with regulatory requirements applicable to Medicaid and other health care programs. The Compliance Lead will analyze business requirements, provide research and regulatory interpretation, and advise internal business units and external business partners in delivering results in a manner that minimizes compliance risk exposure for the Company. Responsible for completing risk assessments, creating annual work plans to audit and monitor plan performance, and for supporting the implementation of new contracts through readiness review activities. The Compliance Lead will directly manage and/or give day-to-day work direction to other Compliance Associates

Humana is seeking a Compliance Lead to assist with the development and implementation of Medicaid compliance program oversight and monitoring plans, which includes completing risk assessments and creating annual work plans to audit and monitor performance for Humana Medicaid contracts.  The Compliance Lead facilitates process consistency across contracts and performs ongoing functions to ensure compliance with internal initiatives as well as federal and state regulations.  This position will support Medicaid business growth by contributing to implementation and readiness review activities for newly awarded contracts.  As a Compliance Lead for our Medicaid business, you will be part of a fast-growing team who develops and maintains key relationships both internally with Humana operational leaders as well as externally with our business partners, the State Medicaid Office and/or the Centers for Medicare and Medicaid Services (CMS).  While working within assigned areas to optimize business results, you will:

• Support Medicaid business growth by contributing to implementation and readiness review activities for newly awarded contracts;
• Provide on-going oversight and monitoring of Medicaid business operations to ensure full compliance and minimize risk for the Enterprise;
• Assist with completion of risk assessments and create annual work plans to audit and monitor performance;
• Interpret and define regulatory and contract requirements to be implemented by appropriate Humana Departments and/or external business partners in support of Medicaid;
• Coordinate and manage a standard set of data relating to regulatory standards;
• Review and analyze market documents and data to identify what can be used to evidence meeting regulatory standards;
• Communicate with and present to outside regulators;
• Work across Humana operational units and product lines to enhance data analytics and operational improvement efforts;
• Build relationships with Medicaid market and shared services business units;
• Complete special projects as assigned by Associate Director in support of team objectives and other strategic initiatives.
• Directly manage and/or give day-to-day work direction to other Compliance Associates. 

Use your skills to make an impact
 

Required Qualifications

• Bachelor’s degree in related field
• 3 years experience working in a Compliance-related or managed care-related field
• Experience working with regulatory agencies, including state departments of health insurance and/or CMS
• Knowledgeable in process improvement and metrics development
• Knowledgeable in regulations governing health care industries
• Strong communication skills

Preferred Qualifications

• Juris Doctor or Masters of Business Administration
• Experience in Health Plan Operations
• Leadership experience

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 decisions will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc.

 

$102,200 - $140,700 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 car