Be an early applicantLess than 25 applicants

Company

Humana · 21 hours ago

Senior Risk Management Professional

United States

Full-time

Remote

Mid, Senior Level

$77K/yr - $106K/yr

1+ years exp

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Health CareHealth Insurance

H1B Sponsor Likely

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Responsibilities

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.

Qualification

Find out how your skills align with this job's requirements. If anything seems off, you can easily click on the tags to select or unselect skills to reflect your actual expertise.

Regulatory ComplianceUtilization ManagementClinical OperationsMicrosoft WordMicrosoft ExcelMicrosoft PowerPointMicrosoft OutlookContract ReviewsNursing Degree

Required

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

Certification in area of expertise

Experience with Contract reviews for Medicare and/or Medicaid

Nursing/healthcare or Juris Doctor (JD) Degree

Benefits

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

Company

Humana

Glassdoor

3.8

Humana is a health insurance provider for individuals, families, and businesses.

Founded in 1964

Louisville, Kentucky, USA

10,001+ employees

http://www.humana.com

H1B Sponsorship

Humana has a track record of offering H1B sponsorships. Please note that this does not guarantee sponsorship for this specific role. Below presents additional info for your reference. (Data Powered by US Department of Labor)

Distribution of Different Job Fields Receiving Sponsorship

Represents job field similar to this job

Trends of Total Sponsorships

2023 (217)

2022 (257)

2021 (258)

2020 (107)