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

The Senior Risk Management Professional identifies and analyzes potential sources of loss to minimize risk. The Senior Risk Management Professional work assignments involve moderately complex to complex issues where the analysis of situations or data requires an in-depth evaluation of variable factors.

The Senior Risk Management Professional works as a collaborative First Lines of Defense partner, facilitating proactive identification and evaluation of internal and external conditions and trends which could impact Humana through compliance, financial, operational, or strategic risk. This role consults on business-driven, risk-based decision-making which leads to proactive mitigation of risk and development of applicable monitoring of threats to clinical/UM strategy.

Responsibilities include:

• Research new or emerging regulatory guidance (Medicare and Medicaid):
  • Identify pertinent Utilization Management contractual and regulatory language from state and/or federal documents.
  • Partner with the clinical operations Shared Services to identify operational impacts.
  • Consult on Compliance Plan for identified Impacts, and validate effectiveness of implementation.
• Influence development of appropriate and effective controls.
• Partner with operational areas on identified risk to document the full landscape.
• Actively partner with Regulatory Compliance and Internal Audit, as required.
• Focus on the "big picture" and thrive in a fast paced, independent, multi-project work environment.
• Build and maintain key working relationships across Humana related to your assigned functional area; consult with operations on ad hoc risk/operational inquiries and requests for guidance.

Use your skills to make an impact
 

Required Qualifications - Be sure to include a resume with your application.

• Minimum 1 year in a position focused on researching Regulatory Compliance for Medicare and/or Medicaid
• Clinical Operations knowledge of Utilization Management processes and policies
• Successful track record in building and maintaining positive cross-functional relationships
• Proven ability to work independently and remain organized in a fast paced, multi-project work environment.
• Proficiency in Microsoft Word, Excel, PowerPoint, Outlook
• Excellent communication skills, both oral and written

Preferred Qualifications

• Certification in area of expertise
• Experience with Contract reviews for Medicare and/or Medicaid
• Nursing/healthcare or Juris Doctor (JD) Degree

Work-At-Home Requirements

To ensure Home or Hybrid Home/Office associates’ ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office associates must meet the following criteria:

• At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is recommended; wireless, wired cable or DSL connection is suggested
• Satellite, cellular and microwave connection can be used only if approved by leadership
• Associates 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 associates 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

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.

 

$76,800 - $105,800 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 caregi