Become a part of our caring community and help us put health first

The Senior Risk Management Professional identifies and analyzes potential sources of loss to minimize risk. The Senior 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 Senior Risk Management Professional works as a collaborative First Lines of Defense partner, facilitating proactive identification and evaluation of internal and external conditions and trends which could impact Humana through compliance, financial, operational, or strategic risk. This role consults on business-driven, risk-based decision-making which leads to proactive mitigation of risk and development of applicable monitoring of threats to clinical/UM strategy .

Responsibilities include:

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.

Use your skills to make an impact

Required Qualifications - Be sure to include a resume with your application.

Minimum 1 year in a positionfocused 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 Qualifications

Certification in area of expertise

Experience with Contract reviews for Medicare and/or Medicaid

Nursing/healthcare or Juris Doctor (JD) Degree

Work-At-Home Requirements

To ensure Home or Hybrid Home/Office associates’ ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office associates 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

Associates 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 associates 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 information

Scheduled Weekly Hours

40

Pay Range

The 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 year

This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance.

Description of Benefits

Humana, 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 us

Humana Inc. (NYSE: HUM) is committed to putting health first – for our teammates, our customers and our company. Through our Humana insurance services and 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, Medicaid, families, individuals, military service personnel, and communities at large.

Equal Opportunity Employer

It 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.

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.