MHPAEA Risk and Compliance Senior Professional

Humana; United States; Remote; USD 86,000 - 119,000; Full time

Job summary

An established industry player is seeking a Senior Risk Professional to oversee Medicaid MHPAEA compliance. This role involves managing risks, conducting assessments, and collaborating with stakeholders to ensure audit readiness. You will act as a Subject Matter Expert, develop risk management strategies, and represent the organization in external audits. If you're passionate about healthcare and compliance, this opportunity offers a chance to make a significant impact in a supportive environment that values health and well-being.

Benefits

Medical Insurance

Dental Insurance

Vision Insurance

401(k)

Paid Time Off

Disability Insurance

Life Insurance

Internet Expense Reimbursement

Qualifications

• 3+ years in Utilization, Care, or Case Management.
• 2+ years in healthcare or insurance regulations.

Responsibilities

• Oversee risks related to Medicaid utilization management programs.
• Develop and implement risk management plans and compliance programs.

Skills

Utilization Management

Risk Management

Analytical Skills

Problem-Solving

Communication Skills

Education

Bachelor's degree or equivalent experience

Higher education in healthcare or risk management

Job description

MHPAEA Risk and Compliance Senior Professional

Pay: Competitive

Location: Remote

Employment type: Full-Time

Job Description

• Req#: R-373618

Join our caring community and help prioritize health

The Medicaid MHPAEA (Mental Health Parity and Addiction Equity Act) Senior Risk Professional oversees risks related to Medicaid utilization management (UM) programs to ensure compliance with MHPAEA regulations. Responsibilities include maintaining regulatory requirement libraries, developing risk management strategies, conducting assessments, and collaborating with stakeholders for audit readiness.

Humana seeks an experienced Utilization Management expert to support Medicaid MHPAEA compliance and risk oversight. The UM Risk team acts as the first line of defense for Clinical Operations, managing operational risks proactively, supporting compliance culture, and preparing for external audits. The Senior Professional will analyze MHPAEA requirements, assess operational implementation, maintain documentation, manage information requests, support audit readiness, and assist with remediation efforts.

Key functions include:

• Serve as a Subject Matter Expert on MHPAEA risk and requirements, collaborating with Regulatory Compliance, Legal, Internal Audit, and Government Affairs.
• Develop and implement risk management plans; prepare reports for senior management.
• Create and maintain a MHPAEA compliance program for Clinical NQTLs, evaluating processes against parity standards.
• Stay updated on MHPAEA guidance; ensure timely implementation across Medicaid programs.
• Represent Humana in external MHPAEA audits, managing documentation, data collection, and issue resolution.
• Work with partners to develop and implement remediation plans for compliance issues.
• Conduct regular risk assessments to identify potential non-compliance areas.

Use your skills to make an impact

Required Qualifications:

• Bachelor’s degree or equivalent experience
• 3+ years in Utilization, Care, or Case Management
• 2+ years in healthcare or insurance regulations
• Proven ability to build cross-functional relationships and drive accountability
• Ability to work independently and manage time effectively
• Strong analytical and problem-solving skills
• Attention to detail and proactive risk mitigation
• Effective communication skills in writing and speaking

Preferred Qualifications:

• Experience with MHPAEA regulations and oversight
• Bachelor’s or higher in healthcare, risk management, or related fields
• Certifications in risk management or compliance within healthcare
• Experience with Medicaid programs
• Data analysis experience for risk identification

Additional Information

Home or Hybrid employees must meet internet speed requirements: minimum 25 Mbps download and 10 Mbps upload. Satellite, cellular, or microwave connections require approval. Employees in California, Illinois, Montana, or South Dakota receive bi-weekly internet expense payments. Humana provides necessary telephone equipment and a dedicated workspace to protect member PHI/HIPAA data.

We use HireVue for interviews, which allows flexible scheduling. Applicants may need to provide their SSN during the process.

Occasional travel to Humana offices for training or meetings may be required.

Scheduled Weekly Hours: 40

Pay Range: $86,300 - $118,700 annually, based on location and experience. Bonus incentives are available based on performance.

Benefits: Humana offers comprehensive benefits including medical, dental, vision, 401(k), paid time off, disability, life insurance, and more.

Application deadline: 05-04-2025

About us

Humana is committed to health and well-being, providing services that improve quality of life for diverse communities.

Equal Opportunity Employer

Humana does not discriminate based on race, color, religion, sex, orientation, gender identity, national origin, age, marital status, genetic info, disability, or veteran status. We promote affirmative action and employment equity.

About the company

Humana works to create personalized health paths for every individual.