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

Humana Healthy Horizons in Ohio is seeking a Senior Compliance Professional who ensures compliance with governmental requirements. The Senior Compliance Professional work assignments involve moderately complex to complex issues where the analysis of situations or data requires an in-depth evaluation of variable factors.

You will be part of a caring community at Humana. When you meet us, you can tell we started as a hometown company. We’re proud of our Louisville roots and, as we’ve grown, that community feeling has spread across all 50 states and Puerto Rico. No matter where you are—whether you’re working from home, from the field, from our offices, or from somewhere in between—you’ll feel welcome here. We’re a caring community made of close-knit teams, cross-country friendships, and inclusive resource groups, all gathered around one big table where everyone’s voice is heard and respected. Community is a verb here. It’s up to each of us to care for it and maintain it. Because the relationships we form will help us deliver better health outcomes for the people we so proudly serve.

Are you Caring, Curious and Committed? If so, apply today!

The Senior Compliance Professional develops and implements compliance policies and procedures. Researches compliance issues and recommends changes that assure compliance with contract obligations. Maintains relationships with government agencies. Coordinates site visits for regulators, coordinates implementation and compliance with corrective action plans, as needed. Begins to influence department’s strategy. Makes decisions on moderately complex to complex issues regarding technical approach for project components, and work is performed without direction. Exercises considerable latitude in determining objectives and approaches to assignments.

Key Responsibilities

• Manage, Organize and Monitor the internal Humana Ohio Medicaid mailbox

• Create reports, spreadsheets and Power Point presentations

• Lead various Project Management Projects

• Execute intake and tracking process and ensure changes are centrally documented in the Regulatory Repository

• Coordinate and compose time sensitive responses to incoming regulatory inquiries and issues reflective of compliance with program requirements

• Collaborate with internal business owners to ensure accurate and timely delivery of documents, including reports, prior to submission to regulatory agencies

• Develop and maintain schedules of state and Federal deadlines and deliverables and ensure timely submission of accurate deliverables

• Provide interpretation and guidance to the organization in regard to regulatory requirements and government contract administration

• Lead the communication of annual and interim contract amendments in conjunction with appropriate business owners

• Interact with regulators within the scope of responsibilities

• Participate in Regulatory audits and site visits

• Works collaboratively to develop and deliver compliance training programs, ensuring organizational workforce are knowledgeable of applicable laws

• Establish and maintain collaborative working relationship with assigned regulatory agency and other key industry stakeholders.

• Develop and maintain relationships with key internal and external stakeholders to ensure successful collaboration

• Identify and recommend performance improvement opportunities

• Report potential risks, non-compliance or alleged violations to Leadership

Use your skills to make an impact
 

Required Qualifications

• Bachelor's degree

• 3+ years of managed care experience

• Knowledge/understanding of laws and regulations governed by the Ohio Department of Medicaid

Preferred Qualifications

• Advanced or graduate degree

• Project Management experience or PMP certification

• Audit or consulting experience

• Experience with metrics and reporting

Additional Information

About Humana

Your growth is what drives Humana forward. 

• When you get here, the journey is just beginning. Our leaders are committed to understanding what you need to grow. Because we don’t grow without you
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• Where every associate can build a professional path where they learn and thrive.
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