Humana Manager, Risk Management - Remote in US in Pittsburgh, Pennsylvania
The Manager, Membership and Plan Services (MPS) Risk Management will be responsible to lead a team of risk professional associates to help identify risk, oversee implementation to drive operational excellence, advance compliance results, and improve audit readiness.
Where you Come In
The Manager, MPS Risk Management will:
Design, deliver, and drive internal compliance measures through the implementation of operational policies, procedures, and controls, which ensure adherence to all new and changing legislation for Medicare and Medicaid.
Will identify and analyze potential sources of loss to minimize risk and work on problems of diverse scope and complexity ranging from moderate to substantial.
Manage the execution of internal and external audit reviews, risk assessments, process reviews, and other risk mitigation activities.
Ability to influence without direct control.
Ability to exercise independent judgement and decision making.
Review documentation for compliant policies and procedures.
Work and influence across multiple teams to improve compliance, risk mitigation, and operational efficiencies.
Strong business acumen: understands how the business works and demonstrates consistently effective 'navigation' across the organization.
Must demonstrate knowledge of the legal and regulatory environment, as it relates to compliance in Medicare and Medicaid.
Manage a team of risk management professionals to partner with operations while growing and fostering talent.
Create a culture of empowerment and speaking up by fostering world class engagement and well-being.
What Humana Offers
We are fortunate to offer a remote opportunity for this job. Our Fortune 100 Company values associate engagement & your well-being. We also provide excellent professional development & continued education.
Required Qualifications - What it takes to Succeed
Minimum of 5 years Risk Management experience
Minimum of 3 years of Medicare, Medicaid, and/or legislative/regulatory experience, knowledge in regulations governing health care industries
Minimum of 3 years prior experience in leading cross-functional initiatives to improve business results
Minimum of 3 years prior leadership experience managing a team to grow and execute
Comprehensive knowledge of Microsoft Office applications Excel, Visio, PowerPoint, Word tools
Possess a solid understanding of operations, technology, communications, and processes
Professional image and excellent communication skills, both oral and written
High School Diploma, GED or job related certification
Experience with Enterprise Solution Point (ESP) or other GRC platforms
Previous experience in Medicare, Medicaid, Medicare Advantage, and Billing & Reconciliation strongly preferred.
Additional Information - How we Value You
Benefits starting day 1 of employment
Competitive 401k match
Generous Paid Time Off accrual
Go365 perks for well-being
Must have a separate room with a locked door that can be used as a home office to ensure you have absolute and continuous privacy while you work.
Must have accessibility to high speed DSL or cable modem for a home office (Satellite internet service is NOT allowed for this role); and recommended speed for optimal performance from Humana systems is at minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps.
As part of our hiring process, we will be using an exciting interviewing technology provided by Modern Hire, a third-party vendor. This technology provides our team of recruiters and hiring managers an enhanced method for decision-making.
If you are selected to move forward from your application prescreen, you will receive correspondence inviting you to participate in a pre-recorded Voice Interview and/or an SMS Text Messaging interview. If participating in a pre-recorded interview, you will respond to a set of interview questions via your phone. You should anticipate this interview to take approximately 10-15 minutes.
If participating in a SMS Text interview, you will be asked a series of questions to which you will be using your cell phone or computer to answer the questions provided. Expect this type of interview to last anywhere from 5-10 minutes. Your recorded interview(s) via text and/or pre-recorded voice will be reviewed and you will subsequently be informed if you will be moving forward to next round of interviews.
In order to support the CDC recommendations on social distancing and reduce health risks for associates, members and public health, Humana is deploying virtual and video technologies for all hiring activities. This position may be subject to temporary work at home requirements for an indefinite period of time. These requirements include access to a personal computing device with a camera, a minimum internet connection speed of 10m x 1m, and a dedicated secure home workspace for interview or work purposes. Humana continues to monitor the situation, and will adjust service levels as the coronavirus situation evolves. The following changes are temporary and will be evaluated frequently with the goal of returning to normal operations as soon as possible. Your Talent Acquisition representative will advise on the latest recommendations to protect your health and wellbeing during the hiring process.
Scheduled Weekly Hours