HCS Compliance amp Risk Management Senior Professional

Profile

Description

The Senior Risk Management Professional identifies and analyzes potential sources of loss to minimize risk. The Senior Risk Management 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 Risk Management Professional estimates the potential financial consequences of an occurring loss. Develops and implements controls and cost-effective approaches to minimize the organization's risks. Assesses and communicates information regarding business risks with functions across the organization. Begins to influence department's 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.

Assignment Capsule

Use your experience in process consulting to support compliance within the Healthcare Services (HCS) organization. As a HCS Compliance & Risk Management Professional, you will work with the Clinical Operations teams and HCS Chief Medical Office to provide assurance around the effectiveness and efficiency of Medicare/Medicaid compliance and operational processes:


Research new or emerging regulatory guidance, work with operations to ensure timely implementation, and validate effectiveness of implementation.
Perform targeted audits/reviews of processes and documentation to identify operational and compliance risks/gaps; develop, oversee, and validate implementation of remediation activities.
Develop a comprehensive understanding of operational processes; document process narratives and identify key internal controls to ensure ongoing compliance.

Work with business partners to develop comprehensive remediation plans for issues identified internally and by Regulatory Compliance or Internal Audit. Support the implementation of remediation plans and validation of effectiveness prior to submission for closure review.
Build and maintain key working relationships across Humana related to your assigned functional area; consult with operations on ad hoc compliance/operational inquiries and requests for guidance.
Support internal and external audit activity as a subject matter expert on processes and controls under review - facilitate the remediation of audit findings by providing recommendations and parting with business owners to ensure plans are implemented timely and effectively.
Actively partner with Regulatory Compliance, Internal Audit, and the Chief Risk Office, as required.


Role Essentials


Bachelor's degree in Business, Nursing, or equivalent experience in a related field
Internal/External Audit, process improvement or and/compliance oversight experience
Successful track record in building and maintaining positive cross-functional relationships
Likes to focus on the big picture and thrives in a fast paced, independent, multi-project work environment
Excellent communication skills, both oral and written
Proficiency in Microsoft Word, Excel, PowerPoint, Outlook


Role Desirables:


Knowledge of regulations governing health care industries
Experience utilizing Microsoft Visio
Certification in area of expertise


Scheduled Weekly Hours

40

Company info

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