Director of Program Delivery
Not Disclosed•Full-TimeRemote
location_onCarlos Gilbert Elementary School, 300, Griffin Street, Santa Fe, Santa Fe County, New Mexico, 87501, United States
About the Team
Humana is a leading U.S. healthcare company dedicated to making it easier for millions of people to achieve their best health. Through our insurance services and CenterWell healthcare services, we deliver the care and support our members need when they need it. Our mission extends to improving the quality of life for people with Medicare and Medicaid, families, military personnel, and communities across the nation.
About the Role
As the Director, Risk Management Quality Audit, you will serve as a strategic leader within our caring community, identifying and analyzing potential sources of loss to minimize organizational risk. This role is critical for ensuring the integrity of Humana's risk adjustment programs, with a primary focus on developing and executing strategies that guarantee complete and accurate data submission to the Centers for Medicare and Medicaid Services (CMS).
In this position, you will drive a positive culture that embodies the "Humana way" while managing the oversight of all coding quality audits. You will be responsible for responding accurately and timely to regulatory audits and ensuring the successful execution of the annual compliance program for coding accuracy. Beyond operational execution, you will evaluate organizational resources to support current work and determine future enhancements to the team. Reporting to the Associate VP of Risk Adjustment, you will leverage key partnerships across the organization—including Quality, Cost & Strategy, market risk adjustment associates, and legal and regulatory compliance partners—to inform future strategies and minimize risk regarding risk adjustment data.
Work location
Work model: Remote
Carlos Gilbert Elementary School, 300, Griffin Street, Santa Fe, Santa Fe County, New Mexico, 87501, United States
Santa Fe, New Mexico
Key Responsibilities
- check_circleExecute regulatory risk adjustment audits to minimize financial impacts and identify improvement opportunities
- check_circleProvide compliance oversight over risk adjustment activities through defined programs and key metrics
- check_circleRespond accurately and timely to regulatory audits while ensuring annual coding accuracy compliance
- check_circleDevelop and execute strategy for oversight of risk adjustment programs to ensure accurate data submission
- check_circleEstablish and manage team goals, priorities, staffing, and budgets
- check_circleEnsure operational excellence of all coding quality audits conducted by the team
- check_circleDrive development of analytics on audit data to inform future risk minimization strategies
Requirements
- verified5+ years of project and people leadership experience
- verified8-10+ years of experience in strategic operations, analytics, process improvement and stakeholder influence
- verified5+ years of experience in program development and management
- verified5+ years of Process Improvement and operations experience
- verifiedHigh-speed DSL or cable modem (25x10 speed)
- verifiedDedicated workspace free of interruptions
Nice to Have
Experience in communication with external regulators. Experience in presenting to senior leadership.
Benefits & Perks
check_circleMedical, dental, and vision benefitscheck_circle401(k) retirement savings plancheck_circlePaid time off, company holidays, and personal holidayscheck_circleVolunteer time offPaid parental and caregiver leave
