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

Humana is seeking a Manager, Quality Assurance (External LTSS Oversight Team Manager) who will lead a team of Quality Assurance Professionals responsible for ensuring consistency of use and compliance to state and Humana requirements for Long-Term Services and Supports (LTSS) eligibility determination and service authorization. The Manger, Quality Assurance collaborates with external partners such as Area Agencies on Aging (AAA) and assist with monitoring day-to-day operational activities with AAAs. The Manager, Quality Assurance works within specific guidelines and procedures; applies advanced technical knowledge to solve moderately complex problems; receives assignments in the form of objectives and determines approach, resources, schedules, and goals.

• Oversee the External Oversight Team (Quality Assurance professionals and Care Management Support Assistants) staff and monitors compliance with Home and Community-Based Services (HCBS) eligibility determination, service authorization, and other key LTSS compliance or operational metrics as identified. 
• Responsible for planning and overseeing the daily operations of the team which includes making decisions related to resources and approach for projects and initiatives involving own departmental area and requires cross departmental collaboration.
• Conduct briefings, area meetings, and maintains frequent contact with internal and external stakeholders such as other Humana departments.
• Liaise and maintain frequent contact with external stakeholders and vendors such as Area Agencies on Aging, conducts briefings and area meetings,
• Develop policies and procedures to ensure compliance with state and federal requirements and incorporate industry best practices.
• Provide real-time training/re-training to downstream entities on ongoing compliance requirements, policies, and procedures.
• Support leadership in meeting goals of the department/market.
• May participate in Interdisciplinary team meetings.

Use your skills to make an impact
 

Required Qualifications

• Must reside in the state of Michigan.
• An active, unrestricted Registered Nurse (RN) license or an active, unrestricted Licensed Social Worker (LBSW or LMSW) in the state of Michigan.
• Three (3) or more years of professional experience working with complex populations, home and community-based services or in managed care settings.
• Two (2) or more years of management or supervisory experience.
• Proficiency in analyzing and interpreting data trends.
• Comprehensive knowledge of all Microsoft Office applications, including Outlook, Word, Excel and PowerPoint.
• Exceptional oral and written communication and interpersonal skills with the ability to quickly build rapport.
• This role is considered patient facing and is part of Humana’s Tuberculosis (TB) screening program. If selected for this role, you will be required to be screened for TB.

Preferred Qualifications

• Certified Care Manager (CCM).
• Three (3) or more years of managed care experience in Medicare and/or Medicaid, specifically in the delivery of care for the elderly or special needs populations such as the Aged, Blind and Disabled (ABD) and those enrolled in Long-Term Services and Supports (LTSS) Waiver Services, in hospice and/or in nursing facilities.
• Proficiency in analyzing and interpreting financial trends.
• Previous experience in utilization management, discharge planning and/or home health or rehabilitation.
• Experience with initiating service plans for members.
• Experience with disease management, health promotion, coaching and wellness.
• Health Plan experience.
• Bilingual or Multilingual: English/Spanish, Arabic, Chaldean Neo-Aramaic, or other - Must be able to speak, read and write in both languages without limitations or assistance. See “Additional Information” for more information.

Additional Information

• Workstyle: This is a remote position that requires some travel.
• Travel: Up to 25% travel is anticipated to meet with providers across Michigan, including participation in team engagement meetings at Humana’s Detroit office location and attendance at conferences throughout the state.
• Typical Workdays and Hours: Monday – Friday; 8:00am – 5:00pm Eastern Standard Time (EST).
• Direct Reports: Up to 15.
• Language Proficiency Assessment: Any Humana associate who speaks with a member in a language other than English must take a language proficiency assessment, provided by an outside vendor, to ensure competency. Applicants will be required to take the Interagency Language Rating (ILR) test a