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.

Work at Home Requirements

• At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is recommended; wireless, wired cable or DSL connection is suggested.

• Satellite, cellular and microwave connection can be used only if approved by leadership.

• Associates 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 associates 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.

Preferred Qualifications

• Expertise on NCQA accreditation standards, especially related to Utilization Management and/or Behavioral Health.

• Registered Nurse or Behavioral Health Licensed Professional.

• Managed care, Medicaid health plan experience

Additional information

• Workstyle: Remote

• Location: US

• Schedule: Monday through Friday 8:00 AM – 5:00 PM Eastern and able to accommodate schedules and meetings in both Central and Eastern time zones.

• Travel: 5% travel – typically, 3-5 times annually possibly outside of your state of residence for team engagement meetings, onsite audits, and trainings.

Interview Format

As part of our hiring process, we will be using an exciting interviewing technology provided by Modern Hire/Montage, a third-party vendor.  This technology provides our team of recruiters and hiring managers an enhanced method for decision-making.

If you are selected to move forward from your application prescreen, you will receive correspondence inviting you to participate in a pre-recorded Voice Interview and/or an SMS Text Messaging interview.  If participating in a pre-recorded interview, you will respond to a set of interview questions via your phone. You should anticipate this interview to take approximately 10-15 minutes.

If participating in a SMS Text interview, you will be asked a series of questions to which you will be using your cell phone to answer the questions provided.  Expect this type of interview to last anywhere from 5-10 minutes. Your recorded interview(s) via text and/or pre-recorded voice will be reviewed, and you will subsequently be informed if you will be moving forward to next round of interviews.

Social Security Task

Alert: Humana values personal identity protection.  Please be aware that applicants being considered for an interview will be asked to provide a social security number, if it is not already on file.  When required, an email will be sent from