Job Overview
Location
Remote Nationwide
Job Type
Full-time
Category
Other
Date Posted
April 22, 2026
Full Job Description
đź“‹ Description
- • The Compliance Lead ensures compliance with governmental requirements and oversees clinical utilization management for Medicare Part C, playing a critical role in maintaining regulatory adherence and improving consumer healthcare experiences.
- • Day to day, the role involves researching and applying healthcare laws and regulations, serving as a subject matter expert on prior authorizations and quality of care, developing audit methodologies, conducting monitoring activities, tracking compliance metrics, and advising executives on functional strategies for compliance.
- • The Compliance Lead partners with Enterprise Compliance teams, leads audit preparations for CMS program audits, presents findings to stakeholders, and participates in committees to provide compliance guidance across Humana’s operations.
- • In this role, the individual will deepen expertise in Medicare Part C compliance, lead cross-functional compliance initiatives, influence executive decision-making, and gain experience navigating complex regulatory landscapes in a major healthcare organization.
🎯 Requirements
- • Bachelor’s Degree
- • 8 or more years of compliance or audit related experience
- • Advanced experience with building, collecting, validating, and communicating large sets of data
- • Experience with Medicare Part C Clinical Utilization Management
- • Project Management Professional (PMP) certification (preferred)
- • Leadership experience (preferred)
🏖️ Benefits
- • Medical, dental, and vision benefits
- • 401(k) retirement savings plan
- • Paid time off including company and personal holidays, volunteer time off, and paid parental and caregiver leave
- • Short-term and long-term disability, life insurance
- • Eligibility for bonus incentive plan based on company and/or individual performance
Skills & Technologies
About Humana Inc.
Humana Inc. is a for-profit health and well-being company headquartered in Louisville, Kentucky. Founded in 1961, it provides health insurance, Medicare Advantage plans, Medicaid services, pharmacy benefit management, and clinical care through primary care centers. Serving millions of members across the United States, Humana focuses on integrated care delivery, home health, and wellness programs aimed at improving health outcomes and reducing costs for individuals, employers, and government partners.
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