Humana

About Humana

 

Job Category:

Risk & Compliance - Compliance

Country:

United States

Postal Code:

40201

Approximate Salary:

Not Specified

Position Type:

Full Time

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Associate Director Compliance, Health Care Delivery

Humana - Louisville, Kentucky

Posted: 10/31/2018

Description

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).

Responsibilities

The Associate Director, Compliance 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. Responsible for management of a staff.  Decisions are typically related to identifying and resolving complex technical and operational problems within department(s), and could lead multiple managers or highly specialized professional associates.


Humana is seeking an Associate Director to oversee compliance programs for health care delivery partners and practices, including primary care and hospice providers, as well as model of care and other services in support of Humana’s Special Needs Plans (SNPs).  The Associate Director oversees compliance health care delivery associates to analyze business requirements, provide research and regulatory guidance, and advise internal business units and external business partners in delivering results in a manner that minimizes compliance risk exposure for the Company. 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:

  • Provide on-going oversight and monitoring of health care delivery partners and practices to ensure full compliance and minimize risk for the Enterprise;
  • Provide on-going oversight and monitoring of SNP plan model of care requirements and other clinical delivery services as appropriate;
  • Provide regulatory guidance and contract requirements as needed to appropriate Humana Departments and/or external business partners in support of health care delivery; 
  • Oversee the health care delivery compliance team to review and analyze documents and data as evidence to meet compliance and regulatory standards;
  • Work across Humana operational units and product lines to enhance data analytics and operational improvement efforts
  • Perform assessments, develop action plans, and provide guidance to health care delivery partners and practices;
  • Build relationships with health care delivery leaders and partners;
  • Serve as a translator between Humana and assigned health care delivery partners and practices to assist with the interpretation of the intention of guidelines and regulatory requirements;
  • Provide end to end analysis of the compliance program of potential acquisition targets as needed;
  • Coordinate on-site audits, working with the health care delivery partners.   

               

Required Qualifications

  • Bachelor’s degree
  • 6 or more years of working in compliance, risk management, or managed-care field
  • 2 or more years of 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 CMS
  • Knowledgeable in provider compliance programs and processes 
  • Knowledgeable in process improvement and metrics development
  • Knowledgeable in regulations governing health care industries
  • Travel to provider and partner sites approximately 10%

Preferred Qualifications

  • Juris Doctor or Masters of Business Administration
  • 3 plus years of experience in Health Plan Compliance or Operations
  • Knowledgeable in home health, hospice, licensure, practice management
  • Knowledgeable in CMS Special Needs Plan programs and processes

Scheduled Weekly Hours

40

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