**Become a part of our caring community and help us put health first** The Medicaid MHPAEA (Mental Health Parity and Addiction Equity Act) Senior Risk Professional is responsible for overseeing and managing risks associated with Medicaid utilization management (UM) programs to ensure compliance with MHPAEA regulations. This role involves maintaining the library of regulatory requirements, developing, and implementing risk management strategies, conducting risk assessments, and collaborating with various stakeholders to ensure audit readiness. Humana is seeking a seasoned expert in Utilization Management to join the UM Risk Management team and help support Medicaid MHPAEA (Mental Health Parity and Addiction Equity Act) compliance and risk oversight. The UM Risk team serves as the “1st line of defense” for Humana’s Clinical Operations segment, delivering a comprehensive operational risk management program with an eye toward prevention, timely detection, and swift remediation of risks and issues. The team focuses on identifying risks and issues, driving implementations and other special projects to promote operational excellence, consulting with business operators on key initiatives and challenges, infusing a compliance culture throughout the organization, and ensuring external audit readiness. The Mental Health Parity Senior Professional will analyze MHPAEA requirements, assess operational implementation, create and maintain supporting documentation, manage information requests related to MHPAEA compliance, support MHPAEA audit readiness, and assist with remediation of issues identified. **Key functions of this role include:** + Serve as a Subject Matter Expert on MHPAEA risk and requirements at an enterprise-level, actively partnering with other Humana oversight groups including Regulatory Compliance, Legal, Internal Audit, and Government Affairs and providing guidance and support as needed. + Develop and implement comprehensive risk management plans to proactively identify and mitigate identified risks. Prepare detailed risk reports and present findings to senior management. + Develop and maintain a comprehensive MHPAEA compliance program for Clinical NQTLs. Evaluate existing processes/factors/evidentiary standards against parity requirements using policies, procedures, data analysis, and case-level auditing. + Stay apprised of existing, new, or emerging regulatory guidance related to MHPAEA; work closely with operational business units to ensure understanding of guidance and timely implementation. Ensure Medicaid programs adhere to MHPAEA requirements and other relevant federal and state regulations. + Represent Humana Clinical Operations on all MHPAEA-related external audits and requests - inclusive of audit timeline management, documentation and data collection/review, audit response development, and issue/gap resolution. This role may interface with external regulators on occasion. + Work with business partners to develop comprehensive remediation plans for issues identified. Support the implementation of remediation plans and validation of effectiveness prior to closure. Promote a culture of compliant and continuous improvement within the organization. + Conduct regular risk assessments to identify potential areas of non-compliance. **Use your skills to make an impact** **Required Qualifications** + Bachelor’s degree or equivalent experience + 3+ years of experience with Utilization Management, Care Management or Case Management + 2+ years of experience with healthcare or insurance regulations + Successful record of building and maintaining positive cross-functional relationships and driving shared accountability + Ability to work independently and effectively allocate time + Strong analytical and problem-solving abilities + Attention to detail and proactive approach to identifying and mitigating risks + Demonstrated ability to articulate ideas effectively in both written and oral forms **Preferred Qualifications** + Experience with Mental Health Parity and Addiction Equity Act (MHPAEA) regulations and/or oversight + Bachelor’s degree or higher in healthcare, risk management, or a related field. + Experience and/or certifications in risk management, compliance, or a related role within the healthcare sector + Experience with Medicaid programs + Experience analyzing data sets for purposes of risk identification **Additional Information** To ensure Home or Hybrid Home/Office employees’ ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office employees must meet the following criteria: + At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is required; wireless, wired cable or DSL connection is suggested. + Satellite, cellular and microwave connection can be used only if approved by leadership. + Employees who live and work from Home in the state of California, Illinois, Montana, or South Dakota will be provided a bi-weekly payment for their internet expense. + Humana will provide Home or Hybrid Home/Office employees with telephone equipment appropriate to meet the business requirements for their position/job. + Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information. As part of our hiring process for this opportunity, we will be using an interviewing technology called HireVue to enhance our hiring and decision-making ability. HireVue allows us to quickly connect and gain valuable information from you pertaining to your relevant skills and experience at a time that is best for your schedule. Humana values personal identity protection. Please be aware that applicants may be asked to provide their Social Security Number, if it is not already on file. When required, an email will be sent from Humana@myworkday.com with instructions on how to add the information into your official application on Humana’s secure website. **Scheduled Weekly Hours** 40 **Pay Range** The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc. $86,300 - $118,700 per year This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance. **Description of Benefits** Humana, Inc. and its affiliated subsidiaries (collectively, “Humana”) offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities. Application Deadline: 03-12-2025 **About us** Humana Inc. (NYSE: HUM) is committed to putting health first – for our teammates, our customers and our company. Through our Humana insurance services and CenterWell healthcare services, we make it easier for the millions of people we serve to achieve their best health – delivering the care and service they need, when they need it. These efforts are leading to a better quality of life for people with Medicare, Medicaid, families, individuals, military service personnel, and communities at large. **Equal Opportunity Employer** It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or veteran status. It is also the policy of Humana to take affirmative action to employ and to advance in employment, all persons regardless of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment. Humana complies with all applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, sex, sexual orientation, gender identity or religion. We also provide free language interpreter services. See our https://www.humana.com/legal/accessibility-resources?source=Humana_Website.