• Job Description

  Req#: R-380969

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

  The Director, Compliance ensures compliance with governmental requirements. The Director, Compliance requires an in-depth understanding of how organization capabilities interrelate across the function or segment.

  The Director, Compliance ensures compliance with governmental requirements. The Director, Compliance requires an in-depth understanding of how organization capabilities interrelate across the function or segment.

  The Director of Compliance (Contract Administrator) will report directly to the State Market Leader for Medicaid (Ohio CEO) and board of directors on all compliance issues and will manage the connection of MCO personnel to the Ohio Department of Medicaid business owners. They will also develop and implement written policies, procedures, and standards to ensure compliance with requirements set forth in the Contract.

  This individual identifies and analyzes potential sources of loss to minimize risk.

  • Serves as the primary point of contact for all MCO compliance issues
  • Coordinating the tracking and submission of all contract deliverables; including fielding and coordinating responses to ODM inquiries
  • Coordinating, preparing for, and facilitating random and periodic audits and site visits.
  • Assesses and communicates information regarding business risks with functions across the organization representation in Internal Compliance committees and managing LRRs
  • Coordinates the preparation and execution of Contract documents, audits, and ad‐hoc visits
  • Advises executives to develop functional strategies on matters of significance
  • Uses independent judgment requiring analysis of variable factors and determines the best course of action
  • Participate in required Compliance meetings with the Ohio Department of Medicaid
  • Monitors all functional areas for compliance with the Medicaid contract and follow up for corrections of deficiencies
  • Directs implementation of plan projects, state contract initiatives, executive-sponsored initiatives and risk assessments
  • Leads compliance monitoring to identify process gaps, validate compliance levels, map processes, oversee implementation of corrective actions, prepare reports/presentations
  • Develops strategic plans, makes recommendations to leadership, assesses and communicates information regarding business risks with functions across the organization
  • Oversees development, execution and compliance with Business Continuity Plan and associated state reporting
  • Develops strong relationships with external state partners and internal leaders to identify and address compliance risks and failures
  • Ensures the preparation and execution of state ad hoc requests aligns to requirements
  • Ensure program compliance with federal, state, and contractual requirements; collaborate with appropriate business areas to develop policies, procedures, and systems to secure and demonstrate compliance with all mandates
  • Research potential compliance issues and recommend changes that assure compliance with contract obligations
  • Develop and implement compliance policies and procedures
  • Ensure the tracking and timely submission of all Contract deliverables
  • Maintain relationships with ODM and other relevant government agency contacts
  • Participate in Ohio program integrity and Medicaid compliance forums and programs
  • Oversee resolution of ODM Contract compliance issues, including corrective action plans
  • Field and coordinate responses to ODM inquiries
  • Monitor and understand emerging Medicaid policy; provide recommendations and direction in the implementation of new initiatives to be compliant with emerging policy

  
  Use your skills to make an impact
  

  Required Qualifications

  • Bachelor’s Degree
  • Must reside in Ohio
  • 8 or more years of experience in operations or compliance‐related field
  • 5 or more years of management experience
  • Experience working with regulatory agencies, including sate departments of health insurance or CMS
  • Extensive knowledge and experience working with state administrative codes and regulations, Medicaid, managed care, and insurance laws and regulations
  • Experience with Microsoft Office Applications: Word, PowerPoint & Excel
  • Knowledgeable in process improvement and metrics development and in regulations governing healthcare industries
  • Strong communication skills
  • Travel 10%

  Preferred Qualifications

  • Masters/JD preferred
  • 5 or more years experience

  Additional Information

  As part of our hiring process for this opportunity, we will be using an interviewing technology called HireVue to enhance our hiring and decision-making ability. HireVue allows us to quickly connect and gain valuable information from you pertaining to your relevant skills and experience at a time that is best for your schedule.

  To ensure Home or Hybrid Home/Office employees’ ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office employees must meet the following criteria:
  
  At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is required; wireless, wired cable or DSL connection is suggested.
  Satellite, cellular and microwave connection can be used only if approved by leadership.
  Employees 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 employees 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.

  Travel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be required.

  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.

  
  

  $150,000 - $206,300 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 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.

• About the company

  Humana looks at every facet of your life and works with you to create a path to health that fits your unique needs

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