Senior Risk Management Professional

$76,800 - $105,800/Yr

Humana - Boston, MA

Full-time - Mid Level

Remote - Boston, MA

Insurance Carriers and Related Activities

About the position

The Senior Risk Management Professional plays a crucial role in identifying and analyzing potential sources of loss to minimize risk within the organization. This position involves complex issues requiring in-depth evaluation of various factors and works collaboratively as a First Lines of Defense partner. The role focuses on proactive identification and evaluation of internal and external conditions that could impact the organization through compliance, financial, operational, or strategic risk, leading to informed decision-making and risk mitigation strategies.

Responsibilities

• Research new or emerging regulatory guidance (Medicare and Medicaid)
• Identify pertinent Utilization Management contractual and regulatory language from state and/or federal documents
• Partner with the clinical operations Shared Services to identify operational impacts
• Consult on Compliance Plan for identified impacts and validate effectiveness of implementation
• Influence development of appropriate and effective controls
• Partner with operational areas on identified risk to document the full landscape
• Actively partner with Regulatory Compliance and Internal Audit, as required
• Focus on the 'big picture' and thrive in a fast-paced, independent, multi-project work environment
• Build and maintain key working relationships across Humana related to your assigned functional area; consult with operations on ad hoc risk/operational inquiries and requests for guidance.

Requirements

• Minimum 1 year in a position focused on researching Regulatory Compliance for Medicare and/or Medicaid
• Clinical Operations knowledge of Utilization Management processes and policies
• Successful track record in building and maintaining positive cross-functional relationships
• Proven ability to work independently and remain organized in a fast-paced, multi-project work environment
• Proficiency in Microsoft Word, Excel, PowerPoint, Outlook
• Excellent communication skills, both oral and written

Nice-to-haves

• Certification in area of expertise
• Experience with Contract reviews for Medicare and/or Medicaid
• Nursing/healthcare or Juris Doctor (JD) Degree

Benefits

• Medical, dental and vision benefits
• 401(k) retirement savings plan
• Paid time off
• Company and personal holidays
• Volunteer time off
• Paid parental and caregiver leave
• Short-term and long-term disability
• Life insurance