Humana Program Manager - Care Delivery Organization in Louisville, Kentucky

Role: Program Manager - Care Delivery Organization Assignment: Compliance Location: Louisville, KY

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.

Assignment Capsule This position will assist the Compliance Officer in developing and overseeing aspects of the Corporate Compliance Program related to Humana’s rapidly expanding Care Delivery Organization. The position helps assure that Humana is in compliance with the rules and regulations applicable to medical practices. This position also ensures that company policies and procedures are being followed, and that behavior in the organization meets the company’s Standards of Conduct. * Oversees development and updates of Care Delivery Organization policies and procedures under the Compliance Program and its related activities to prevent illegal, unethical, or improper conduct. Periodically reviews and updates Standards of Conduct to ensure continuing currency and relevance in providing guidance to management and employees.

  • Collaborates with other departments and leaders to direct compliance issues to appropriate existing channels for investigation and resolution. Consults with the counsel as needed to resolve difficult legal compliance issues.

  • Oversees development of auditing and monitoring processes and work plan for the Care Delivery Organization

  • Ensures response to alleged violations of rules, regulations, policies, procedures, and Standards of Conduct by evaluating or recommending the initiation of investigative procedures.

  • Develops and oversees a system for uniform handling of such violations.

  • Acts as an independent review and evaluation body to ensure that compliance Issues/concerns within the organization are being appropriately evaluated, investigated and resolved.

  • Manages team of compliance personnel

  • Monitors, and as necessary, coordinates compliance activities of other departments to remain abreast of the status of all compliance activities and to identify trends.

  • Identifies potential areas of compliance vulnerability and risk; develops/implements corrective action plans for resolution of problematic issues, and provides general guidance on how to avoid or deal with similar situations in the future.

  • Provides reports on a regular basis, and as directed or requested, to keep the Board and senior management informed of the operation and progress of compliance efforts.

  • Ensures proper reporting of violations or potential violations to duly authorized regulatory and enforcement agencies as appropriate and/or required.

  • Provides compliance monitoring of Humana’s joint venture and alliance provider partners

  • Institutes and maintains an effective compliance communication program for the Care Delivery Organization, including promoting (a) use of the Compliance Hotline; (b) heightened awareness of Standards of Conduct, and (c) understanding of new and existing compliance issues and related policies and procedures.

  • Works with others as appropriate to develop an effective compliance training program, including appropriate introductory training for new employees as well as ongoing training for all employees and managers

  • Coordinates and performs due diligence reviews for potential acquisition targets.

    Role Essentials

  • Bachelor Degree

  • Prior leadership experience

  • Knowledge of regulations governing healthcare industry

  • 3-5 years working in a physician practice or in other healthcare related compliance or legal area

  • Strong written and verbal communication skills

  • Possess the capacity to maintain confidentiality and work independently

  • Are self-motivated and possess the ability to manage multiple priorities and work under pressure to meet deadlines

  • Strong PC skills including web enabled technologies such as internet based applications; Microsoft Word, Excel, PowerPoint Role Desirables

  • JD from accredited law school

  • Certification in Healthcare Compliance (CHC)

  • Knowledge of the healthcare insurance industry a plus

  • Prior work experience with project management and government agency negotiations is a plus

  • Experience interacting with governmental agencies a plus

Additional Information

At Humana, we’re also committed to making the resources available to you that will enable you to become happier, healthier, and more productive in all areas of your life. We know your well-being is important to you, and it’s important to us too. If you share our passion for helping people, we likely have the right place for you at Humana.

After applying, we encourage you to join our Talent Network as well, so you can stay informed and up to date on what’s happening around our organization in the changing world of healthcare.

Title: Program Manager - Care Delivery Organization

Location: KY-Louisville

Requisition ID: 177789