Become a part of our caring community and help us put health first
 

We are seeking a Senior Accreditation Professional who will work in a team environment on Humana’s health plan accreditations, performing complex tasks related to compliance with accreditation standards across multiple operational areas within Humana.

Role Responsibilities:

• Serves as subject matter expert on NCQA Health Plan Accreditation UM requirements, advising stakeholders on compliance, and facilitating NCQA UM survey activities.

• Works closely with operational areas to prepare documentation and files for presentation to NCQA.

• Advises operational leaders and frontline associates in developing functional strategies for compliance with accreditation standards.

• Self-directed, exercises independent judgement and decision-making on complex issues regarding job duties and related tasks, and works under minimal supervision.

• Uses independent judgement requiring analysis of variable factors and determining the best course of action.

Use your skills to make an impact
 

Required Qualifications

• Bachelor’s Degree or BSN degree.
• Minimum 3 years of experience in NCQA Health Plan Accreditation and/or Utilization Management
• Exceptional attention to detail.
• Demonstrated excellent time management skills with proven ability to be flexible, adapt to changing environment, handle multiple tasks and deadlines and manage multiple priorities.
• Commitment to continuous process improvement.
• Exceptional verbal and written communication skills.
• Demonstrated successful relationship building.
• Experience working with cross-functional business areas.

Preferred Qualifications

• Expertise on NCQA accreditation standards, especially related to Utilization Management and/or Behavioral Health; MED-Deeming accreditation standards knowledge is a plus.
• Registered Nurse or Behavioral Health Licensed Professional.
• Managed care, Medicaid health plan experience

Additional Information

• Schedule: Monday through Friday 8:00 AM – 5:00 PM ET and able to accommodate schedules and meetings in both Central and Eastern time zones.
• Work Location (Address): Nationwide Stateside
• Work Style (Remote, Office, Hybrid, Field): Remote
• Travel Requirements (Percentage and Scope): 5% travel – typically, 3-5 times annually possibly outside of your state of residence for team engagement meetings, onsite audits, and trainings.

Work at Home Requirements

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.

Interview Format

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.

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Travel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be required.

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.

 

$78,400 - $107,800 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

Hum