Role: Clinical Compliance Strategic Consultant
Assignment: Healthcare Services
Location:Louisville, KY - Humana Tower
Healthcare isn’t just about health anymore. It’s about caring for family, friends, finances, and personal life goals. It’s about living life fully. At Humana, we want to help people everywhere, including our associates, lead their best lives. We support our associates to be happier, healthier, and more productive in their professional and personal lives. We encourage our people to build relationships that inspire, support, and challenge them.
We promote lifelong well-being by giving our associates fresh perspective, new insights, and exciting opportunities to grow their careers. At Humana, we’re seeking innovative people who want to make positive changes in their lives, the lives of our members, and the healthcare industry as a whole.
The Clinical Compliance Strategic Consultant contributes to the success of Humana’s business strategy by supporting risk and compliance initiatives across Clinical Operations teams within the Healthcare Services organization. As a Clinical Compliance Strategic Consultant, you will be responsible for identifying operational and compliance risks, evaluating internal and external audit results, researching new/emerging regulatory guidance, and performing ongoing monitoring and oversight.
- Review CMS, NCQA, and state-based regulations; provide guidance to business owners on implementation of the requirements and validate effectiveness of the implementation.
- Design and/or oversee and track the compliance-based QA results of all clinical groups for reporting to operational and segment leadership
- Perform targeted reviews of processes, documentation, metrics, and data sets to identify operational and compliance risks/gaps; develop and oversee implementation of remediation activities.
- Work with operational leaders to ensure alignment between systems, internal/external reporting, operational processes, and monitoring and oversight procedures.
- Support internal and external audits: Lead data/universe preparation initiatives, coach associates on audit presentation skills, review supporting documentation submissions, communicate audit findings to business owners, and work with impacted parties to implement remediation plans for issues identified.
- Work collaboratively with other oversight groups including Regulatory Compliance and Internal Audit
- Bachelor’s degree in Business, Nursing, or a related field
- Expertise of regulations governing the health care industry (Medicare, Medicaid, NCQA)
- Experience in Process Consulting and/or Process Improvement
- Proven track record of driving change in complex organizations
- Excellent facilitation skills
- Ability to work in a self-directed manner on multiple projects concurrently
- Proficiency in Microsoft Word, Excel, PowerPoint & Outlook
- Experience using Humana’s Clinical Guidance Exchange (CGX) Platform
- Project management/process management experience
- Working knowledge of SharePoint, Visio, Microsoft Access
- Certification in area of expertise
You will report to a Clinical Compliance Director. This area is under the leadership of the Segment President, Healthcare Services.
Title: Clinical Compliance Strategic Consultant
Requisition ID: 178876