19 days old

Senior Compliance Professional - Medicare Pharmacy Operations

Humana
Louisville, KY 40207
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. The focus of this role is Medicare Pharmacy and Part D. Responsibilities The Senior Compliance Professional develops and implements compliance policies and procedures. Researches compliance issues and recommends changes that assure compliance with regulatory and contract obligations. Provides compliance guidance, direction and compliance risk assessment to assigned business partners, conducts periodic compliance reviews of business partner operations. Monitors metrics and other oversight tools that indicate business area compliance. Recommends new measures of compliance performance. Works with systems to track issues and corrective actions, when needed. Begins to influence departments strategy. Makes decisions on moderately complex to complex issues regarding technical approach for project components, and work is performed without direction. Exercises considerable latitude in determining objectives and approaches to assignments. The Senior Compliance Professionals primary focus will be to develop and implement a plan to monitor and audit business processes to prevent, detect, and resolve compliance issues to help ensure an effective compliance program for Medicare Pharmacy and Part D. Key Responsibilities May Include + Research, understand and apply laws, regulations, and regulatory guidance for Part D and Medicare Pharmacy. + Develop audit methodology and perform auditing and monitoring activity 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. + Provide back-up and support to other Enterprise Compliance team members and perform other duties, as needed. Required Qualifications + Bachelor's degree + 5+ years of experience in regulatory law, compliance, audit, consulting, project management, and/or risk management. + Demonstrated ability to run large-scale, highly-visible programs with responsibility for multiple project teams + High level of emotional intelligence + Knowledge/understanding of laws and regulations governed by CMS and other regulatory agencies Preferred Qualifications + J.D. or other graduate degree + Knowledge of the healthcare insurance industry + Experience interacting with governmental agencies + Experience with metrics and reporting + Part D/Pharmacy experience Scheduled Weekly Hours 40 About Us Mission: At Humana, our cultural foundation is aligned to helping members achieve their best health by delivering personalized, simplified, whole-person healthcare experiences. Recognizing healthcare needs continue to evolve for each person, for each family and for each community, Humana continuously creates innovative solutions and resources that help people live their healthiest lives on their terms when and where they need it. Our employees are at the heart of making this happen and thats why we are dedicated to building an organization of dynamic talent whose experience and passion center on putting the customer first. Equal Opportunity Employer It is our policy to recruit, hire, train, and promote people without regard to race, color, religion, sex, national origin, age, sexual orientation, gender identity or expression, disability, or veteran status, except where age, sex, or physical status is a bona fide occupational qualification. View the EEO is the Law poster. If you are an individual with a disability and require a reasonable accommodation to complete any part of the application process, or are limited in the ability or unable to access or use this online application process and need an alternative method for applying, you may contact mailbox_tas_recruit@humana.com for assistance. Humana Safety and Security Humana will never ask, nor require a candidate provide money for work equipment and network access during the application process. If you become aware of any instances where you as a candidate are asked to provide information and do not believe it is a legitimate request from Humana or affiliate, please contact mailbox_tas_recruit@humana.com to validate the request. <>

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Posted: 2020-02-07 Expires: 2020-03-08

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Senior Compliance Professional - Medicare Pharmacy Operations

Humana
Louisville, KY 40207

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