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The Associate Director, Compliance ensures compliance with governmental requirements. The Associate Director, Compliance requires a solid understanding of how organization capabilities interrelate across department(s). The Associate Director, Compliance manages dedicated compliance officers who implement compliance programs in support of Medicaid contracts, maintains annual auditing and monitoring work plans, researches compliance issues and recommends changes that assure compliance with contract obligations. Maintains relationships with government agencies. Oversees implementation and compliance with corrective action plans, as needed.
Humana is seeking an Associate Director to oversee compliance programs for Humana’s Medicaid contracts. The Associate Director oversees compliance associates who are dedicated compliance officers in support of Medicaid state contracts. The team is responsible for analyzing business requirements, providing research and regulatory interpretation, and advising internal business units and external business partners in delivering results in a manner that minimizes compliance risk exposure for the Company. Responsible for overseeing completion of risk assessments and annual work plans to audit and monitor performance. As an Associate Director, 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. While working within assigned areas to optimize business results, you will:
- Develop strategy and provide on-going oversight and monitoring of Medicaid contracts to ensure full compliance and minimize risk for the Enterprise;
- Oversees compliance team to review and analyze market documents and data to identify what can be used to evidence meeting compliance and regulatory standards;
- Oversee compliance team to audit and monitor performance, and report to leadership top risks, remediation plans and other information as appropriate
- Oversee completion risk assessments and annual work plans to audit and monitor performance.
- Perform assessments, develop action plans, and provide guidance to internal business units;
- Interpret and define regulatory and contract requirements to be implemented by appropriate Humana Departments and/or external business partners in support of Medicaid;
- Communicate with and present to outside regulators as needed;
- 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;
- Participate in external audits as needed, working with business partners and other compliance teams.
- Participate in state level and corporate compliance level meetings.
- Report out to leadership status of activities or risk on a monthly
Additional Information:
- This person would report to Director of Regulatory Complianc
Use your skills to make an impact
Role Essentials
- Bachelor’s degree
- 5 or more years of experience working in a Compliance-related, risk management and/or managed care-related field
- 2 or more years management and/or leadership experience
- Strong communication skills with the ability to influence effectively
- Experience working with regulatory agencies, including state departments of health insurance and/or CMS
- Knowledgeable in regulations governing health care industries
Role Desirables
- Juris Doctor or Masters of Business Administration
- Experience in Medicaid operations/programs
- Knowledgeable in process improvement and metrics development
- Knowledgeable in compliance programs and processes
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.
$123,800 - $170,400 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 caregiver leave), short-term and long-term disability, life insurance and many other opportunities.
About us
Humana Inc. (NYSE: HUM) is committed to putting health first – for our teammates, our customers and our company. Through our Humana insurance services and 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, Medicaid, families, individuals, military service personnel, and communities at large.
Equal Opportunity Employer
It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or veteran status. It is also the policy of Humana to take affirmative action to employ and to advance in employment, all persons regardless of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment.
