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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 connect