Compliance Manager

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The Compliance Manager plays a vital role in ensuring adherence to governmental regulations within our organization. This position tackles a diverse array of compliance challenges, with a primary focus on clinical Utilization Management (UM) for Medicare Part C.

In this pivotal role, you will craft and enforce compliance policies, address compliance inquiries, and recommend necessary changes to meet contractual obligations. You will forge strong relationships with government agencies and coordinate site visits for regulators, while also managing the implementation of corrective actions as necessary. You will provide strategic advice to executive leadership on critical compliance matters and will operate with minimal supervision, making independent judgments on complex issues.

Your Key Responsibilities Will Include:

• Thoroughly researching, understanding, and applying laws and regulations pertinent to Health and Clinical Services (HCS) operations, particularly those related to prior authorizations, quality of care, and clinical programs in the Medicare Part C arena.
• Acting as the subject matter expert for HCS operations, particularly surrounding prior authorizations and clinical programs for Medicare Part C.
• Creating audit methodologies and conducting auditing and monitoring activities to identify noncompliance issues, providing guidance on necessary remedial actions.
• Analyzing business needs and complex issues while providing regulatory insights to business units and compliance leaders.
• Establishing and tracking compliance metrics to proactively identify potential issues.
• Collaborating with the Enterprise Compliance team on regulatory engagements.
• Serving as the Regulatory Compliance expert during audits conducted by the Centers for Medicare & Medicaid Services (CMS).
• Leading preparation efforts for onsite program audits and overseeing business audit prep to ensure timely and complete submissions to regulators.
• Communicating audit findings to business partners and compliance leaders, and tracking issues to ensure prompt resolution.
• Participating in and leading committees, providing compliance insights and direction.
• Supporting other members of the Enterprise Compliance team as needed.

Make an Impact with Your Skills

Required Qualifications:

• Bachelor's Degree.
• Eight or more years of experience in compliance or auditing.
• A passion for enhancing consumer experiences in organizational settings.
• Advanced skills in data handling: building, validating, and communicating large data sets.
• Experience with Medicare Part C Clinical Utilization Management.

Preferred Qualifications

• Advanced graduate degree.
• Project Management Professional (PMP) certification.
• Six Sigma certification.
• Previous leadership experience.

Additional Information:

This is a remote position, but occasional travel to Humana's offices may be required for training and meetings.

Scheduled Weekly Hours: 40

Compensation Range: We offer a competitive compensation range of $115,200 - $158,400 per year, depending on experience and qualifications. This position also includes eligibility for a bonus incentive plan based on individual and company performance.

Description of Benefits: Humana provides a comprehensive benefits package aimed at supporting your overall well-being, including health care options, a retirement savings plan, generous time-off policies, and other value-added benefits.

Application Deadline: June 29, 2026

About Us: Humana Inc. is a leading healthcare company dedicated to improving the health of the communities we serve. Our mission is to simplify healthcare and provide excellent service to our members.

Equal Opportunity Employer: Humana is committed to fair employment practices and does not discriminate based on any protected status. We also ensure accessibility for all individuals.