Remote Contract Integrity Lead: Program Compliance

Humana Inc; Carson City (NV); Teletrabalho; USD 95 000 - 131 000; Tempo integral

Resumo da oferta

Humana, Inc. is seeking a PI Contract Lead to join the leadership team. This role focuses on ensuring compliance with CCN program requirements and regulatory mandates, translating contract requirements into actionable processes and monitoring frameworks.

Responsibilities include cross-functional collaboration, root-cause analyses, and development of corrective actions. Remote work option with travel as needed, supporting integrated care planning and risk mitigation.

Qualificações

• 5+ years of Program Integrity and/or Payment Integrity experience
• 2+ years of project management experience
• Must have ONE of the listed antifraud degrees/certifications
• Current experience with understanding claims adjudication, systems and reporting
• Knowledge of healthcare-related applications and technology
• Ability to manage and prioritize multiple initiatives with minimal guidance
• Excellent communication and presentation skills to senior/executive leadership
• Results-driven mindset to achieve goals
• Experience reading and interpreting contracts/policy/operations manuals
• Proficiency in Microsoft Office (Excel, PowerPoint, Word)
• US citizenship is required for this DoD contract
• Must successfully receive NBIS government security clearance
• HGB restriction: not eligible in Puerto Rico

Responsabilidades

• Translate contract requirements into business processes, workflows, controls, procedures and requirements
• Identify operational gaps and recommend process changes; develop SOPs and training materials
• Establish and maintain a contract monitoring framework; track performance, SLAs, KPIs and deliverables
• Apply Lean, Six Sigma, RCA and other methods to improve contract performance
• Conduct routine reviews to ensure alignment with contractual obligations

Conhecimentos

Program Integrity

Project management

Communication

Data analysis

Lean Six Sigma

Risk assessment

Leadership

Formação académica

RN/BSN

CPC

CCS

CCDS

CHC

HCAFA

AHFI

CFE

JD

Ferramentas

Microsoft Excel

PowerPoint

Word

Descrição da oferta de emprego

Humana, Inc. is seeking a PI Contract Lead to join the leadership team. This role focuses on ensuring compliance with CCN program requirements and regulatory mandates, translating contract requirements into actionable processes and monitoring frameworks.

Responsibilities include cross-functional collaboration, root-cause analyses, and development of corrective actions. Remote work option with travel as needed, supporting integrated care planning and risk mitigation.