Associate Director Compliance

Profile

Description

The Associate Director ensures compliance with governmental requirements for Medicaid. The Associate Director develops and implements compliance program oversight and monitoring plans, which includes completing risk assessments, creating annual work plans to audit and monitor performance for all Humana Medicaid contracts, and oversees corrective action plans as needed based. The Associate Director researches compliance issues and recommends changes that assure compliance with contract obligations. The Associate Director is responsible for management of a staff of compliance associates who analyze business requirements, provide research and regulatory interpretation, and advise internal business units and external business partners in delivering results in a manner that minimizes compliance risk exposure for the Company. The Associate Director maintains relationships with external regulators and government agencies, and coordinates site visits for regulators.

Responsibilities

Humana is seeking an Associate Director to oversee compliance programs for Humana's Medicaid contracts. The Associate Director oversees compliance associates to analyze business requirements, provide research and regulatory interpretation, and advise internal business units and external business partners in delivering results in a manner that minimizes compliance risk exposure for the Company. Responsible for completing risk assessments, creating 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

Complete risk assessments and create 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;

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;

Coordinate on-site audits, working with business partners and other compliance teams.

Required Qualifications

Bachelor's degree

5 or more years of experience working in a Compliance-related, risk management and/or managed care-related field

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

Preferred Qualifications

Juris Doctor, MBA, or other graduate degree

Experience in Medicaid operations/programs

Knowledgeable in process improvement and metrics development

Knowledgeable in compliance programs and processes

Additional Information

Scheduled Weekly Hours

40

Company info

Humana Inc.
Website : http://www.humana.com