Compliance Lead

Become a part of our caring communityThe Compliance Lead ensures compliance with governmental requirements. The Compliance Lead works on problems of diverse scope and complexity ranging from moderate to substantial. The focus of this role is compliance and oversight of clinical UM for Medicare Part C.The Compliance Lead develops and implements compliance policies and procedures. Researches compliance issues and recommends changes that assure compliance with contract obligations. Maintains relationships with government agencies. Coordinates site visits for regulators, coordinates implementation and compliance with corrective action plans, as needed. Advises executives to develop functional strategies (often segment specific) on matters of significance. Exercises independent judgment and decision making on complex issues regarding job duties and related tasks. Works under minimal supervision. Uses independent judgment requiring analysis of variable factors and determining the best course of action.Key responsibilities may include:Research, understand and apply laws, regulations, and regulatory guidance for HCS operations, including, but not limited to prior authorizations, quality of care, and clinical programs for the Part C Medicare line of business.Serve as the subject matter expert on HCS operations, including, but not limited to prior authorizations, quality of care, and clinical programs for the Part C Medicare line of business.Develop audit methodology and perform auditing and monitoring activity to prevent and detect issues of noncompliance and provide guidance on remedial actions to strengthen compliance controls and ensure compliance with state and federal laws and regulations.Analyze business requirements and complex issues, conduct research, and provide regulatory guidance to business partners, Law, and Enterprise Compliance associates and leaders with regard to HCS operations, including, but not limited to prior authorizations, quality of care, and clinical programs for the Part C Medicare line of business.Develop and track compliance metrics to help monitor and detect potential compliance issues.Partner with Enterprise Compliance team members on regulatory outreach.Serve as the Regulatory Compliance subject matter expert during CMS program audits.Lead onsite program audit preparation and activity and perform oversight of business audit preparation to ensure timely, accurate and complete submission of required data and documentation to regulators.Present findings of monitoring and auditing efforts to business partners and Enterprise Compliance leaders and track issue to ensure appropriate and timely remediation.Lead and participate on committees, providing compliance guidance and direction.Provide back-up and support to other Enterprise Compliance team members and perform other duties, as needed.Use your skills to make an impactRequired QualificationsBachelor's Degree8 or more years of compliance or audit related experienceMust be passionate about contributing to an organization focused on continuously improving consumer experiencesAdvanced experience with building, collecting, validating, and communicating large sets of dataExperience with Medicare Part C Clinical Utilization Mgt.Preferred QualificationsAdvanced graduate degreeProject Management Professional (PMP) certificationSix Sigma certificationLeadership experienceAdditional InformationTravel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be required.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.$115,200 - $158,400 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.Application Deadline: 06-29-2026About usAbout Humana: Humana Inc. (NYSE: HUM) is a leading U.S. healthcare company. Through our Humana insurance services and our CenterWell healthcare services, we make it easier for the millions of people we serve to achieve their best health – delivering the care and service they need, when they need it. These efforts are leading to a better quality of life for people with Medicare and Medicaid, families, individuals, military service personnel, and communities at large. Learn more about what we offer atHumana.comand atCenterWell.com.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 protected veteran status. It is also the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and VEVRAA, to employ and to advance in employment individuals with 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.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 https://www.humana.com/legal/accessibility-resources?source=Humana_Website.J-18808-Ljbffr