Clinical Compliance & Risk Management Senior Professional -
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Chicago, IL 60684
Humana is seeking a seasoned expert in Mental Health Parity (MHPAEA) to join its Clinical Compliance & Risk Management organization. Clinical Compliance & Risk Management serves as the “1st line of defense” for Humana’s Clinical Operations segment, delivering a comprehensive operational risk management program with an eye toward prevention, timely detection, and swift remediation of risks and issues. On the whole, the team focuses on identifying risks and issues, driving implementations and other special projects to promote operational excellence, consulting with business operators on key initiatives and challenges, infusing a compliance culture throughout the organization, and ensuring external audit readiness. The Mental Health Parity Senior Professional will analyze MHPAEA requirements, assess operational implementation, create and maintain supporting documentation, manage audits and information requests related to MHPAEA compliance, and assist with remediation of issues identified. 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.
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.
Key functions of this role include:
+ Serve as a Subject Matter Expert on MHPAEA risk and requirements at an enterprise-level, actively partnering with other Humana oversight groups including Regulatory Compliance, Legal, Internal Audit, and Government Affairs.
+ Develop and execute a comprehensive MHPAEA Compliance program for Clinical NQTLs. Evaluate existing processes/factors/evidentiary standards against parity requirements using policies, procedures, data analysis, and case-level auditing.
+ Maintain and continuously update all MHPAEA Comparative Analysis documentation.
+ Stay apprised of existing, new, or emerging regulatory guidance related to MHPAEA; work closely with operational business units to ensure guidance is understood and implemented.
+ Represent Humana Clinical Operations on all MHPAEA-related external audits and requests – inclusive of audit timeline management, documentation and data collection/review, audit response development, and issue/gap resolution. This role may be required to interface with external regulators on occasion.
+ Work with business partners to develop comprehensive remediation plans for issues identified. Support the implementation of remediation plans and validation of effectiveness prior to closure.
+ Build and maintain key working relationships across Humana related to your assigned functional area; consult with operations on ad hoc inquiries and requests for guidance.
+ Bachelor’s degree or equivalent experience in a related field
+ 2+ years’ experience with Commercial healthcare/insurance regulations, including the Mental Health Parity and Addiction Equity Act (MHPAEA)
+ Successful track record in building and maintaining positive cross-functional relationships
+ Aptitude for developing a quick understanding of people, processes, and technology
+ Excellent communication skills, both oral and written
+ Comprehensive knowledge of Microsoft Office applications, including Word, Excel, Visio, PowerPoint, and Outlook
+ Must be passionate about contributing to an organization focused on continuously improving consumer experiences
+ Juris Doctorate or other applicable graduate degree
+ Understanding of Clinical Health Plan Operations (such as Utilization Review processes)
+ Experience analyzing data sets for purposes of risk identification
Scheduled Weekly Hours
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 that’s why we are dedicated to building an organization of dynamic talent whose experience and passion center on putting the customer first.
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