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Humana Senior Compliance Professional in Springfield, Missouri

Description

The Senior Compliance Professional ensures compliance with governmental requirements. The Senior Compliance Professional work assignments involve moderately complex to complex issues where the analysis of situations or data requires an in-depth evaluation of variable factors.

Responsibilities

The Senior Compliance Professional will analyze business requirements, provide research and regulatory interpretation, and advise internal business units and external business partners in delivering results in a manner that minimizes compliance risk exposure for the Company. The Senior Compliance Professional also develops and maintains key relationships both internally with Humana operational leaders as well as externally with our business partners. The Senior Compliance Professional's primary focus will be to develop and implement a plan to monitor and audit business processes to prevent, detect, and resolve compliance issues related to Humana's pharmacy services across segments. While working within assigned areas to optimize business results, you will:

  • Cultivate relationships with key partners to ensure compliance alignment on strategic initiatives.

  • Research, understand and apply laws, regulations, and regulatory guidance as applicable for pharmacy services across various segments.

  • Conduct risk assessments and perform auditing and monitoring activities to prevent and detect issues of noncompliance and provide guidance on remedial actions to strengthen compliance controls and ensure compliance with state and federal laws and regulations.

  • Develop and track compliance metrics to help monitor and detect potential compliance issues.

  • Present findings of monitoring and auditing efforts to business partners and Enterprise Compliance leaders and track issue to ensure appropriate and timely remediation.

  • Oversee development and progress of issue remediation; review and analyze documents and data to identify what can be used to evidence meeting regulatory standards;

  • Provide back-up and support to other Enterprise Compliance team members and perform other duties, as needed.

  • Work across Humana operational units and product lines to enhance data analytics and operational improvement efforts.

Required Qualifications

  • Bachelor's degree in related field or equivalent work experience

  • Experience working in a Compliance-related or managed care-related field or pharmacy

  • Experience working with regulatory agencies

  • Knowledgeable in process improvement and metrics development

  • Knowledgeable in regulations governing health care industries

  • Strong communication skills

Preferred Qualifications

  • Juris Doctor or Masters of Business Administration

  • 3 plus years of experience in Health Plan Compliance or Health Plan Operations or Pharmacy/PBM Operations

  • Familiarity with pharmacy operations, laws, or regulations

Additional Information

For this job, associates are required to be fully COVID vaccinated or undergo weekly COVID testing and wear a face covering while at work. The weekly testing will need to be done through an approved Humana vendor, and unvaccinated associates should follow all social distancing and masking protocols if they are required to come into a Humana facility or work outside of their home. We are a healthcare company committed to putting health and safety first for our members, patients, associates, and the communities we serve.

If progressed to offer, you will be required to:

  • Provide proof of full vaccination OR

  • Commit to weekly testing, following all CDC protocols, OR

  • Provide documentation for a medical or religious exemption consideration.

Scheduled Weekly Hours

40

Humana complies with all applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, sex, sexual orientation, gender identity or religion. We also provide free language interpreter services. See our https://www.humana.com/legal/accessibility-resources?source=Humana_Website.

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