Program Integrity Contract Lead - Remote & Compliance Champion

Humana Inc

Nashville (TN)

Remote

USD 95,000 - 131,000

Full time

9 days ago

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Job summary

Humana Inc. is seeking a PI Contract Lead to join the Program Integrity leadership team. The role focuses on translating contract requirements into compliant processes, monitoring performance, and driving corrective actions across cross-functional teams.

You will conduct root-cause analyses and advise leadership on risk mitigation, with emphasis on federal and state regulatory requirements. The position supports remote work with occasional travel to Humana offices for training or meetings, and

Qualifications

5+ years of Program Integrity and/or Payment Integrity experience.
2+ years of project management experience, preferably on large contracts.
Must have one of several anti-fraud degrees, designations or certifications such as RN/BSN, CPC, CCS, CCDS, CHC, HCAFA, AHFI, CFE, or JD.

Responsibilities

Translate contract requirements into business processes, workflows and controls.
Establish and maintain a contract monitoring framework.
Identify operational gaps and recommend process changes.
Apply Lean, Six Sigma and root-cause analysis to improve performance.
Conduct routine reviews to ensure alignment with contracts.
Provide consultative support and training to stakeholders.