99 applicants

Company

Humana · 2 days ago

Senior Risk Management Professional

Remote Nationwide

Full-time

Remote

Mid, Senior Level

$77K/yr - $106K/yr

5+ years exp

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H1B Sponsor Likely

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Responsibilities

Review CMS, NCQA, and state-based regulations; provide guidance to business owners on implementation of the requirements and validate effectiveness of the implementation.

Assess processes, documentation, metrics, and data sets to identify operational and compliance risks/gaps; develop and oversee implementation of remediation activities.

Work with operational leaders to ensure alignment between systems, internal/external reporting, operational processes, and monitoring and oversight procedures.

Support internal and external audits: Lead data/universe preparation initiatives, review supporting documentation submissions, communicate audit findings to business owners, and work with impacted parties to implement remediation plans for issues identified.

Issue and Opportunity Management reporting and oversight for Care Management, including the tracking and reporting of IOPS, enterprise reporting, action plan development and implementation, and serving as a liaison between the issue creator and business.

Provide assurance around the effectiveness and efficiency of Care Management compliance and operational processes.

Perform targeted reviews of processes, documentation, metrics, and data sets to identify strategic, operational and compliance risks/gaps; develop and oversee implementation of remediation activities.

Work in partnership with multidisciplinary teams and key internal and external stakeholders to develop relationships and define business requirements.

Serves as subject matter expert for Care Management program policies, process, and regulatory and/or contractual requirements.

Lead meetings and prepare presentations, reports, and dashboards.

Serve as a problem solver, provide recommendations, and implement change.

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.

Medicare regulationsMedicaid regulationsRisk managementCMS Regulatory GuidelinesEnd-to-end audit processData validationDashboard creationCare management operationsMicrosoft Office proficiencyHumana care management platformsHealthcare data analysisProcess developmentMedicare contractsMedicaid contractsBusiness acumenProject management

Required

Bachelor's degree or 8+ years of commensurate work experience

5+ years’ experience with Medicare and/or Medicaid with knowledge of regulations governing health care industries

5+ years of experience with identifying and mitigating risks and improving business results

Working knowledge of CMS Regulatory Guidelines

Experience with the end-to-end audit process (audit preparation through issue resolution)

Experience with monitoring, metric review and data validations

Experience creating dashboards for data trending, and reporting

Solid understanding of care management/care coordination operations, technology, communications, and processes

Proficiency with all Microsoft Office applications with proficiency working in Outlook, Teams, SharePoint, Excel, PowerPoint, and Word

Travel up to 15-20% (This is concentrated into 1-2 trips per year for on-site audits)

Strong oral and written communication skills

Strong critical thinking and problem-solving skills

Heavy detail-orientation and effective organization skills

Solid business acumen and understanding of how the business works

Must be passionate about contributing to an organization focused on continuously improving consumer experiences

Preferred

Experience with Humana’s care management platforms

Knowledge of Humana’s internal policies and procedures

Proficiency querying and analyzing healthcare data

Process development and implementation experience

Project management/process management experience

Experience with strategic initiatives and implementations

Experience with Medicare and Medicaid contracts

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

10001+ employees

http://www.humana.com

H1B Sponsorship

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Distribution of Different Job Fields Receiving Sponsorship

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Trends of Total Sponsorships

2023 (217)

2022 (257)

2021 (258)

2020 (107)