Senior Healthcare Risk Management Professional

Become a part of our caring community and help us put health firstThe Senior Healthcare Risk Management Professional identifies and analyzes potential sources of loss to minimize risk. The Senior Healthcare Risk Management Professional work assignments involve moderately complex to complex issues where the analysis of situations or data requires an in-depth evaluation of variable factors.The RoleThe Senior Healthcare Risk Professional develops and implements compliance policies and procedures. Research compliance issues and recommends changes that assure compliance with governmental obligations. The Senior Healthcare Risk Professional estimates the potential consequences of an occurring loss and implements controls and cost-effective approaches to minimize the organizations risks. Makes decisions on moderately complex to complex issues regarding the technical approach for project components and work without direction. The Senior Healthcare Risk Professional will:• Manage compliance program oversight of the business by estimating risk, driving auditing and monitoring activities, providing compliance guidance to the business, and tracking relevant laws and regulations and staying current on changes impacting healthcare compliance.• Prepares compliance reports, guidance memoranda, and data analytics for internal senior management, or regulatory agencies as required.• Ensures that project/department milestones/goals are met.• Contributes to annual and longer-range development and implementation of company's risk and compliance assessment plans and compliance work plans.• Proactively identifies and addresses compliance issues, and effectively integrates compliance risks/issues and business knowledge to address compliance issues and/or identified risks.• Leads and/or participates, with limited direction, in cross-functional internal committees, and can represent the Risk Management Department on cross-functional review/decision-making committees of significant impact across the organization.• Develops and provide compliance training.• Assist risk and compliance management and senior leaders with federal, state, and/or administrative disclosure requirements.• Reviews data to determine instances of suspected fraud, waste, and abuse.• Where applicable, manages outside vendors to ensure on-time, on-target, and within-budget deliverables; and• Assists with other Risk Management Department duties and/or projects as assigned.Use your skills to make an impactRequired Qualifications• Bachelor's Degree in a related discipline• A minimum of five years of work experience in healthcare compliance, corporate compliance, healthcare risk management, healthcare policy, legal, or relevant field• Knowledge/understanding of laws and regulations as it relates to healthcare compliance in Medicare, Medicaid, and/or clinical industries (includes anti-kickback and Stark statutes, government fraud, waste, and abuse, false claims, HIPAA/ Privacy, grievances, patient electronic record surveillance, release of information, etc.)• Excellent verbal, interpersonal, and written communication skills• Proven ability to synthesize and summarize complex and/or voluminous content into clear, concise, and actionable communications communication.• Experience effectively identifying, developing, and implementing process improvements; to include 'outside of the box' solutions.• Excellent in building and cultivating relationships with key business partners and stakeholders across organizational levels.• Excellent project management skills: can prioritize multiple tasks and goals to ensure timely, on-target and within-budget accomplishment of such.• Demonstrates intermediate computer skills including Microsoft Office suite of software applications in Excel and PowerPointPreferred Qualifications• Graduate or advanced degree• Previous experience in a healthcare provider organization strongly preferred.• Prior Medicare and/or Medicaid, Medicare Advantage, or government oversight strongly preferred.• Healthcare Compliance Certification or other relevant professional certificationAdditional Information• Ability to travel to the various clinic locations; <20% annually• This is a remote position.• Must work standard business /working hours: 8-5 / Monday - Friday; Eastern or Central Standard TimeWork at Home StatementTo 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 recommended; wireless, wired cable or DSL connection is suggested• Satellite, cellular and microwave connection can be used only if approved by leadership• Employees who live and work from Home in the state of California, Illinois, Montana, or South Dakota will be provided a bi-weekly payment for their internet expense.• Humana will provide Home or Hybrid Home/Office employees with telephone equipment appropriate to meet the business requirements for their position/job.• Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA informationDriving StatementThis role is part of Humana's driver safety program and therefore requires an individual to have a valid state driver's license and must carry insurance in accordance with the state minimum required limits, or $25,000/$25,000/10,000 whichever is higher.Scheduled Weekly Hours40Pay RangeThe compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc.$76,800 - $105,800 per yearThis job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance.Description of BenefitsHumana, Inc. and its affiliated subsidiaries (collectively, 'Humana') offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides 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 and many other opportunities.About usAbout CenterWell Senior Primary Care: CenterWell Senior Primary Care provides proactive, preventive care to seniors, including wellness visits, physical exams, chronic condition management, screenings, minor injury treatment and more. Our unique care model focuses on personalized experiences, taking time to listen, learn and address the factors that impact patient well-being. Our integrated care teams, which include physicians, nurses, behavioral health specialists and more, spend up to 50 percent more time with patients, providing compassionate, personalized care that brings better health outcomes. We go beyond physical health by also addressing other factors that can impact a patient's well-being.About CenterWell, a Humana company: CenterWell creates experiences that put patients at the center. As the nation's largest provider of senior-focused primary care, one of the largest providers of home health services, and fourth largest pharmacy benefit manager, CenterWell is focused on whole-person health by addressing the physical, emotional and social wellness of our patients. As part of Humana Inc. (NYSE: HUM), CenterWell offers stability, industry-leading benefits, and opportunities to grow yourself and your career. We proudly employ more than 30,000 clinicians who are committed to putting health first - for our teammates, patients, communities and company. By providing flexible scheduling options, clinical certifications, leadership development programs and career coaching, we allow employees to invest in their personal and professional well-being, all from day one.Equal Opportunity EmployerIt is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or veteran status. It is also the policy of Humana to take affirmative action to employ and to advance in employment, all persons regardless of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment.Centerwell, a wholly owned subsidiary of Humana, complies with all applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, sex, sexual orientation, gender identity or religion. We also provide free language interpreter services. See our full accessibility rights information and language options https://www.partnersinprimarycare.com/accessibility-resources