Role: Compliance Consultant Assignment: Humana Clinical Pharmacy Review Location: Work From Home Healthcare isn’t just about health anymore. It’s about caring for family, friends, finances, and personal life goals. It’s about living life fully. At Humana, we want to help people everywhere, including our associates, lead their best lives. We support our associates to be happier, healthier, and more productive in their professional and personal lives. We encourage our people to build relationships that inspire, support, and challenge them. We promote lifelong well-being by giving our associates fresh perspective, new insights, and exciting opportunities to grow their careers. At Humana, we’re seeking innovative people who want to make positive changes in their lives, the lives of our members, and the healthcare industry as a whole. Assignment Capsule Humana Clinical Pharmacy Review (HCPR) is responsible for processing prior authorization requests for select medications based on criteria established by our Pharmacy and Therapeutics committee. This ensures that the drugs are used properly in the most appropriate circumstances and are cost-effective. Humana is seeking a Compliance Consultant who will provide an ongoing strategic view and direction to multiple initiatives. You will partner with operations, regulatory compliance, internal audit and risk management in meeting compliance objectives for the organization and with functional leaders and teams to deliver compliant operational results. • Surveys, interprets, and applies laws, regulations, and regulatory guidance affecting Humana clinical pharmacy review and medication intake team • Ensures employees are provided with appropriate training on standard operating procedures, applicable laws, and regulations, and identifies any areas of deficiency • Acts as compliance consultant to all operations and supporting departments • Willingly participates in and/or effectively leads various workgroups, and projects as needed and assigned • Supports regulatory, third party, and accreditation audits including preparation and submission of documentation as needed • Provide guidance and direction to business leaders on the design and implementation of controls to assure compliance • Develop, implement, and monitor standard operating procedures, other documentation, and tools to ensure their accuracy, effectiveness and compliance with all applicable laws, rules and regulations. Participate in the updating and revision of policies and procedures and system controls • Monitor and report on the effectiveness of compliance controls, and guide business on the implementation of corrective actions, as needed • Resolve compliance issues and non-conformances as they occur or are discovered • Lead and participate in teams and committees, providing compliance guidance and direction, and tracking and remediating compliance risks • Creates and supports a culture of compliance for all associates • Identifies potential regulatory and compliance impacts to the business and proactively builds a plan to mitigate risk and/or ensure proper controls are in place to monitor • Seeks compliant resolutions that maximize operational effectiveness Key Competencies • Builds Trust: Consistently models and inspires high levels of integrity, lives up to commitments, and takes responsibility for the impact of one's actions • Interpersonal Effectiveness: Understands oneself, effectively manages emotions, listens and communicates with respect, and builds trusting relationships • Customer Focus: Connects meaningfully with customers to build emotional engagement and customer advocacy. Simplifies complexity and integrates internal efforts to deliver an optimal customer experience • Collaborates: Engages others by gathering multiple views and being open to diverse perspectives, focusing on a shared purpose that puts Humana's overall success first
Role Requirements • Experience with laws, rules, and regulations as it relates to prior authorization reviews • Demonstrated comprehensive, in depth knowledge, of regulatory requirements, with ability to interpret standards and implement processes accordingly • Have prior background working in a compliance related area • Possess the capacity to maintain confidentiality and work independently • Are self-motivated and possess the ability to manage multiple priorities and work under pressure to meet deadlines • Able to quickly develop strong professional working relationships internally and externally • Expertise in working collaboratively and communicating with staff in different positions and all levels of management positions • Solid written and oral communication skills • Excellent computer skills including Microsoft Word, Outlook, Power Point and Excel Roles Desirables • Prior work experience with project management • Experience interacting with state and federal agencies • Working knowledge of SharePoint, Visio, and Access
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