Humana is hiring a Senior Accreditation Utilization Management Professional to join our team dedicated to maintaining NCQA Health Plan Accreditation. In this role, you'll focus on ensuring compliance with Utilization Management standards across multiple operational areas, performing complex tasks in a collaborative environment.
What You'll Do
- Serve as the subject matter expert on NCQA Health Plan Accreditation Utilization Management requirements, advising stakeholders and facilitating survey activities.
- Work closely with operational areas to prepare documentation and files for presentation to NCQA.
- Advise operational leaders and frontline associates in developing functional strategies for compliance.
- Exercise independent judgment and decision-making on complex issues, analyzing variable factors to determine the best course of action with minimal supervision.
What We're Looking For
- A Bachelor’s Degree or BSN.
- A minimum of 3 years of experience in NCQA Health Plan Accreditation and/or Utilization Management.
- Exceptional attention to detail and excellent time management skills.
- Proven ability to be flexible, adapt to a changing environment, handle multiple tasks and deadlines, and manage multiple priorities.
- A commitment to continuous process improvement.
- Exceptional verbal and written communication skills.
- Demonstrated success in relationship building.
- Experience working with cross-functional business areas.
Nice to Have
- Expertise on NCQA accreditation standards, especially related to Utilization Management and/or Behavioral Health; MED-Deeming accreditation standards knowledge is a plus.
- Being a Registered Nurse or Behavioral Health Licensed Professional.
- Managed care or Medicaid health plan experience.
Team & Environment
You will work in a team environment on Humana’s health plan accreditations.
Benefits & Compensation
- Medical, dental, and vision benefits.
- 401(k) retirement savings plan.
- Comprehensive time off, including paid time off, company and personal holidays, volunteer time off, and paid parental and caregiver leave.
- Short-term and long-term disability, life insurance, and other benefits.
- A bonus incentive plan based upon company and/or individual performance.
- Compensation range: $78,400 - $107,800 per year.
Work Mode
This is a remote position open to candidates across the United States.
Humana is committed to putting health first – for our teammates, our customers and our company. It is our policy 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 protected veteran status.