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Humana Manager, Risk Management in Colorado Springs, Colorado

Description

The Manager, Clinical Compliance and Risk serves in a consultative fashion to contribute to the success of Clinical/UM teams within the Clinical Solutions organization. The position is responsible for identifying risk and ensuring appropriate controls exist and are effectively monitored within Clinical Operations. In addition, they will oversee implementation of applicable state and federal legislative and regulatory guidelines, support internal and external audit requests, and will ensure the operations is audit ready.

Responsibilities

The manager leads a team of Risk Management professionals to work within guidelines and procedures; apply advanced technical knowledge to solve moderately complex problems; and receives assignments in the form of objectives and determines approach, resources, schedules and goals. The team works across departments to assess and communicate information regarding business risks - collaborating with operations teams as well as with Retail Business Partners, Regulatory Compliance, Enterprise Risk Office and Internal Audit. Success includes identification of risks and strengthened processes to ensure compliance with regulations, efficient processes and an enhanced member and provider experience. Requires ability to work across silos, conducts briefings and area meetings, and maintain frequent contact with other managers across the department.

Responsibilities include:

  • Create tracking and shared accountability

  • Design, deliver, and drive internal compliance measures through the implementation of operational policies and procedures which ensure adherence to all new and changing legislation for Medicare and Medicaid

  • Identify and analyze potential gaps to minimize risk and work on problems of diverse scope and complexity ranging from moderate to substantial

  • Oversee communication, tracking and support implementation efforts for applicable state and federal legislative and regulatory guidelines, many with diverse scope and complexity

  • Manage the execution of internal and external audit reviews

  • Review documentation for compliant policies and procedures

  • Work and influence across multiple teams to improve compliance and operational efficiencies

  • Create a culture of empowerment and speaking up by fostering world class engagement and well-being

  • Demonstrate in-depth knowledge of the legal and regulatory environment, as it relates to compliance in Medicare and Medicaid

Required Qualifications

  • Bachelor's degree or equivalent work experience

  • Familiarity with CMS Regulatory Guidelines

  • 2+ years of management experience

  • 3+ years of Medicare, Medicaid and knowledge in regulations governing health care industries

  • 3+ years of demonstrated experience in leading complex, cross-functional initiatives to improve business results

  • Possess a solid understanding of operations, technology, communications, and processes

  • Strong presentations/communication skills, both oral and written

  • Comprehensive knowledge of all Microsoft Office applications, and proficiency with Excel, Visio, PowerPoint, Word tools

  • Excellent business acumen: understands how the business works and has demonstrated collaboration across the organization

Preferred Qualifications

  • Experience in CGX

  • Auditor Experience

  • Experience with Humana UM Operational processes

Scheduled Weekly Hours

40

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