Compliance Lead

Role Summary

Become a part of our caring community. The Compliance Lead ensures compliance with governmental requirements. The Compliance Lead works on problems of diverse scope and complexity ranging from moderate to substantial. The Compliance Lead serves as the dedicated Compliance Officer for Michigan 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.

As a Compliance Lead for our Medicaid business, you will be part of a fast-growing team that develops and maintains key relationships both internally with Humana operational leaders and externally with our business partners and oversight agencies. While working within assigned areas to optimize business results, you will:

• Serve as the dedicated Regulatory Compliance Officer for the Michigan Medicaid contract.
• Build relationships with market leadership teams and external regulators.
• Provide ongoing oversight of Medicaid operations from readiness review through contract duration to ensure full compliance and minimize risk for the Enterprise.
• Perform risk assessments and develop and implement annual regulatory compliance auditing and monitoring work plans.
• Oversee corrective action plans and document remediation activities.
• Interpret and define state and federal regulatory and contract requirements for Humana Departments and/or external business partners and provide ongoing guidance.
• Review and analyze market documents and data to identify evidence for meeting regulatory standards.
• Participate in external audits to review document submissions, prepare presenters, and coordinate responses for regulators.
• Work across Humana operational units and product lines to enhance compliance data analytics and operational improvement efforts.
• Coordinate and manage a standard set of data relating to regulatory standards and report compliance issues to senior leadership and compliance oversight committees.
• Chair the Michigan Compliance Committee per approved charter.
• Coordinate compliance-related communication/interaction with outside regulators.
• Coordinate with the Special Investigations Unit (SIU) to operate and maintain an effective fraud, waste and abuse program integrity program.

• Bachelor’s degree in a related field.
• 3+ years of advanced experience working in a Compliance-related or managed care-related field or Medicaid.
• 3+ years interpreting and guiding on regulations and compliance requirements governing the health care industry.
• 3+ years analyzing and reviewing metrics related to contract compliance.

• Juris Doctor and/or advanced degree.
• Audit experience.
• Experience with metrics and reporting.
• Experience working with regulatory agencies, including state departments of health insurance and/or CMS.

In this role you will report to the Associate Director of Compliance. This role is an individual contributor. This role is open to the Kentuckian state circles based on the markets in which the candidate will support. In this role you will have up to 25% domestic travel based on business need.

To ensure Home or Hybrid Home/Office employees’ ability to work effectively, the self‑provided internet service of Home or Hybrid Home/Office employees must meet the following criteria: at minimum, a download speed of 25

Mbps and an upload speed of 10

Mbps is required; wireless, wired cable or DSL connection is suggested. In certain roles, the minimum recommended internet speed required by Humana may not be sufficient for business needs. Humana reserves the right to require associates to upgrade their internet service if necessary. Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information.

While this is a remote position, occasional travel to Humana's offices for training or meetings may be required.

40 hours per week.

$115,200 - $158,400 per year. This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company…