# Quality Assurance Professional

**Company**: Humana Inc.
**Location**: Remote Michigan
**Work arrangement**: remote
**Experience**: senior
**Job type**: full-time
**Salary**: $65,000 - $88,600 per year
**Category**: Healthcare
**Industry**: Healthcare

**Apply**: https://humana.wd5.myworkdayjobs.com/en-US/Humana_External_Career_Site/job/Remote-Michigan/Quality-Assurance-Professional_R-433307?utm_source=yubhub.co&utm_medium=jobs_feed&utm_campaign=apply
**Canonical**: https://yubhub.co/jobs/job_3d56d1dd-3cd

## Description

The Quality Assurance Professional reviews Long-Term Services and Support (LTSS) contractor documentation and performance to ensure compliance with contract scope of work, and state and federal regulations.

You will ensure adherence to policies, procedures, and regulations and to prevent and detect fraud, waste, and abuse to ensure appropriate course of action.

Your responsibilities include:

- Complying, conducting, and summarizing compliance audits/reports to include deficiencies and risks.

- Collecting, reviewing records, summarizing issues, and analyzing data daily, weekly, monthly, or as needed to assess outcome and operational metrics for the team and individuals.

- Conducting inter-rater reliability audits for multiple vendor activities such as Home- and Community-Based Services (HCBS) service calculators and nursing facility level of care determination assessments to ensure accurate and consistent application of state and Humana guidelines.

- Ensuring Michigan Department of Health and Human Services (MDHHS), National Committee for Quality Assurance (NCQA), Centers for Medicare and Medicaid Services (CMS), and Humana Gold-Plus Integrated Policy and Procedures are followed.

- Ensuring auditing is completed timely and communicated with leadership.

- Making decisions regarding own work methods, occasionally in ambiguous situations, and requiring minimal direction and receiving guidance where needed.

**Requirements:**

- Must reside in Michigan or within a 40-mile radius of the Michigan border in Ohio or Indiana.

- Bachelor's degree.

- Two (2) or more years of experience in care management, utilization management, quality assurance, and/or population health supporting the Long-Term Services and Supports (LTSS) population.

- Previous experience working with Managed Care Organization.

- Proficiency in analyzing, tracking, and interpreting data trends to identify improvement opportunities and ensure adherence to operational guidelines, policies, and procedures.

- Proficient with Microsoft Office products including Word, Excel, PowerPoint, and Outlook.

**Preferred Qualifications:**

- Licensed healthcare professional in the state of Michigan: LPN, RN, LMSW, LBSW.

- Previous Medicare/Medicaid, MDHHS, CMS, and NCQA experience.

**Additional Information:**

- This is a remote position.

- Up to 10% travel, including occasional travel for audits, accreditation-related activities, and team engagement meetings at Humana's Detroit, Michigan location.

- Typical Work Schedule: Monday through Friday; 8:00 AM to 5:00 PM Eastern Time (ET).

**Benefits:** Humana offers competitive benefits that support whole-person well-being, including medical, dental, and vision benefits, 401(k) retirement savings plan, time off, short-term and long-term disability, life insurance, and many other opportunities.

## Skills

### Required
- Microsoft Office
- data analysis
- quality assurance
- compliance
- care management
- utilization management
- population health

### Nice to have
- Licensed healthcare professional
- Medicare/Medicaid
- MDHHS
- CMS
- NCQA

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Source: [Apply at humana.wd5.myworkdayjobs.com](https://humana.wd5.myworkdayjobs.com/en-US/Humana_External_Career_Site/job/Remote-Michigan/Quality-Assurance-Professional_R-433307?utm_source=yubhub.co&utm_medium=jobs_feed&utm_campaign=apply)