Senior Accreditation Professional

Position Overview

• Location Type: Remote
• Job Type: Full-time
• Salary: [Salary not specified]

Humana is seeking a Senior Accreditation Professional to join their team, focusing on health plan accreditations and ensuring compliance with accreditation standards across various operational areas. This role involves complex tasks and requires a deep understanding of NCQA Health Plan Accreditation Credentialing (CR) requirements.

Requirements

• Bachelor's degree.
• Three (3) years of experience in NCQA Health Plan Accreditation with a focus on Credentialing Accreditation.
• Prior experience participating in NCQA virtual or onsite surveys.
• Commitment to continuous process improvement.
• Exceptional analytical and critical thinking skills, including problem-solving and proficiency in executing solutions.
• Exceptional attention to detail.
• Demonstrated excellent time management skills with proven ability to be flexible, adapt to changing environments, handle multiple tasks and deadlines, and manage multiple priorities.
• Exceptional verbal and written communication skills.
• Demonstrated successful relationship building.
• Experience working with cross-functional business areas.

Preferred Qualifications

• Credentials Verification Organization (CVO) Certification.
• Registered Nurse or Behavioral Health professional.
• Advanced degree in a healthcare-related field.
• Managed care, Medicaid health plan experience.

Responsibilities

• Serve as a subject matter expert on National Committee for Quality Assurance (NCQA) Health Plan Accreditation Credentialing (CR) requirements and advise stakeholders on compliance.
• Work closely with operational areas to prepare documentation for submission to NCQA.
• Advise operational leaders and frontline associates in developing functional strategies for compliance with accreditation standards.
• Exercise independent judgment and decision-making on complex issues regarding job duties and related tasks, working under minimal supervision.
• Utilize independent judgment requiring analysis of variable factors and determining the best course of action.

Additional Information

• Workstyle: Remote position with some travel.
• Schedule: Monday through Friday; 8:00 AM – 5:00 PM Eastern Standard Time (EST). Must be able to accommodate work schedules and meetings in both Central and Eastern time zones.
• Travel: Up to 5% travel (typically 3-5 times annually, possibly outside of your state of residence for team engagement meetings, onsite audits, and trainings).
• Work from Home Requirements:
  • Internet service: Minimum download speed of 25 Mbps and upload speed of 10 Mbps. Wired cable or DSL connection suggested. Satellite, cellular, and microwave connections require leadership approval.
  • California, Illinois, Montana, or South Dakota residents will receive a bi-weekly internet expense payment.
  • Humana will provide appropriate telephone equipment.
  • Work from a dedicated, interruption-free space to protect member PHI/HIPAA information.
• Interview Format: HireVue technology will be used.
• Scheduled Weekly Hours: 40
• Pay Range: [Pay Range not specified]