Compliance D-SNP Director

This role has ownership for securing and overseeing implementation of Humana’s Dual Eligible Special Needs Plan (D-SNP) State Medicaid Agency Contracts (SMACs) annually as well as securing contracts in new states to support Humana’s sales and membership growth initiatives. This entails:

• Has 4 direct reports and 8 indirect reports
• Negotiates SMACs with state Medicaid agencies
• Ensures compliance cross-functionally across the enterprise with all contract elements and drives implementation efforts
• Engages with CMS Duals Office to influence regulatory guidance for D-SNPs
• Works with state and federal Government Affairs teams to develop comments on proposed regulatory changes to serve Humana’s best interests
• Works with Medicaid and Medicare Organizations to stand up new integrated D-SNPs and assist with developing the future Integrated D-SNP Operating Model
• Assists teams across the enterprise to explain contractual requirements/regulatory guidelines in order to drive compliant internal processes
• Completes all necessary application, MOC and SMAC filing requirements with CMS to ensure Humana’s is compliantly positioned to operate D-SNPs in each state

In addition to being a great place to work, Humana also offers industry leading benefits for all employees, starting your FIRST day of employment. Benefits include:

• Medical Benefits
• Dental Benefits
• Vision Benefits
• Health Savings Accounts
• Flex Spending Accounts
• Life Insurance
• 401(k)
• PTO including 9 paid holidays, one personal holiday, one day of volunteer time off, 23 days of annual PTO, parental leave, caregiving leave, and weekly well-being time
• And more

Required Qualifications

• 5+ years of management experience
• An in-depth knowledge of the Medicare Advantage program, with experience and understanding of Dual Eligible Special Needs Plans (D-SNPs)
• Basic knowledge of Medicaid
• Experience managing relationships with federal and state regulators
• Ability to summarize complex information and tailor communication based on audience (i.e., contracts, federal and state regulations)
• Strong presentation skills with experience presenting to senior leaders
• Ability to manage multiple priorities and work under pressure
• Ability to communicate with all levels, driving strategies and solutions
• Ability to work independently while maintaining focus and managing deliverables to meet critical internal and external deadlines
• Strong analytical and reasoning skills
• Ability to affect change in a highly matrixed organization, leveraging data and facts to influence decision-makers

Preferred Qualifications

• Knowledge/understanding of federal regulations governing dual eligible special needs plans
• Knowledge of Medicaid regulations
• Master's degree

Additional Information

This position will have limited …