Description
Humana is seeking a Manager, Quality Assurance (External LTSS Oversight Team Manager) to 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 successful candidate will collaborate with external partners such as Area Agencies on Aging (AAA) and assist with monitoring day-to-day operational activities with AAAs and other external LTSS partners.
Key responsibilities include:
- Overseeing the External Oversight Team (Quality Assurance professionals and Care Management Support Assistants) staff and monitoring compliance to HCBS eligibility determination, service authorization, and other key LTSS compliance or operational metrics.
- Planning and overseeing daily operations of the team, making decisions related to resources and approach for projects and initiatives.
- Conducting briefings, area meetings, and maintaining frequent contact with internal and external stakeholders.
- Liaising and maintaining frequent contact with external stakeholders and vendors, such as Area Agencies on Aging.
- Developing policies and procedures to ensure compliance with state and federal requirements and incorporating industry best practices.
- Providing real-time training/re-training to downstream entities on ongoing compliance requirements, policies, and procedures.
- Supporting leadership in meeting goals of the department/market.
Requirements:
- Active, unrestricted licensed Registered Nurse (RN) or Licensed Social Worker (LBSW, LLMSW, 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.
- Comprehensive knowledge of Microsoft Office applications, including Excel and PowerPoint.
- Proficiency in analyzing and interpreting data trends.
- Exceptional oral and written communication and interpersonal skills.
Preferred qualifications:
- Care Management certification (CCM).
- Three (3) or more years of managed care experience in Medicare and/or Medicaid.
- 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.
Benefits:
- Medical, dental, and vision benefits.
- 401(k) retirement savings plan.
- Time off (including paid time off, company and personal holidays, paid parental and caregiver leave).
- Short-term and long-term disability.
- Life insurance.
Salary: $104,000 - $143,000 per year.
This job is eligible for a bonus incentive plan.