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Humana Associate Director, Risk Adjustment Integrity Unity (RAIU FWA) in Albany, New York


The Risk Adjustment Integrity Unit (RAIU) Associate Director works collaboratively across the enterprise, communicating both the story and impacts of the highly specialized and critical investigations the unit conducts. This highly significant role takes a seat at the legal and compliance table, for purposes of ensuring this segment of Humana's first line of defense is communicating with key stakeholders and is operating in alignment with Humana's goals and values.


The RAIU Associate Director is directly responsible for the day to day operations of the RAIU unit, including (but not limited to), the oversight and management of a highly specialized/professional team of associates, key decision maker with relation to each investigation, oversight of processes (inclusive of streamlining and efficiency identification), case progression, metric reporting to key executive stakeholders, communicator to legal, compliance, markets, operations, etc... , collaborator and mediator to providers, MSOs, Markets, etc... . This is a provider facing role acting as both mediator and partner to external parties, which is imperative with regards to the success of the unit - ensuring proper identification of fraud, waste and abuse, as well as education opportunities are known, documented and remediated.

The RAIU Associate Director will have a team of 8 amazing associates located throughout the country. This role is work at home with about 20% overnight travel once deemed safe and appropriate. Come join Humana in this exciting leadership opportunity within Fraud, Waste and Abuse for a growing Fortunate 100 company and a leader in the Healthcare Industry.

What you need for success! - Required Qualifications

  • Bachelor's Degree or equivalent years of experience in a similar role

  • 5 years of proven leadership skills and significant experience directly managing a group of seasoned professionals

  • 5 years of progressive experience with Fraud, Waste, and Abuse in a Managed Care setting

  • Proven experience utilizing MS Office desktop applications (Word, Excel, PowerPoint, TEAMs Visio, Project)

  • Demonstrated competency in both oral and written communication skills, including ability to collaborate with and present to executive level leadership, markets, compliance, legal (internal/external) and providers

  • Solid understanding of process/work flow concepts

  • Demonstrated experience understanding and effectively communicating the 'Big Picture' to relevant stakeholders

Work at Home Requirements

  • Must have the ability to provide a high speed DSL or cable modem for a home office (Satellite and Wireless Internet service is NOT allowed for this role). A minimum standard speed for optimal performance of 25x10 (25mbs download x 10mbs upload) is required.

  • A dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information.

What you need to be STAND OUT from the crowd!: Preferred Qualifications

  • Prior experience managing / handling complex data components and effectively translate to a larger audience when necessary

  • Solid Background or prior experience with one or more of the following relative components: Legal (JD), Compliance, Clinical (RN, CPC, etc... ), Risk Adjustment, Operations, Data Analytics (specifically from a risk adjustment perspective), Investigations (CFE)

Additional Information

  • This role would require around 20% overnight travel when deemed safe and appropriate

  • This position has the option to be either In-Office or Hybrid-Home work style for those located in the Louisville KY area.

  • If progressed to offer, you will be required to provide proof of full vaccination or documentation for a medical or religious exemption consideration where allowed by law. Requests for these exemptions should be submitted at least 2 week prior to your scheduled first day of work

Scheduled Weekly Hours