[Remote] Senior Accreditation Professional at Humana

San Antonio, Texas, United States

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Not SpecifiedCompensation

N/AExperience Level

N/AJob Type

Not SpecifiedVisa

N/AIndustries

Requirements

Bachelor’s Degree or BSN degree
Minimum three (3) years of experience in NCQA Health Plan Accreditation and Long-Term Services and Supports (LTSS)
Prior experience participating in NCQA virtual or onsite surveys
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 environment, handle multiple tasks and deadlines and manage multiple priorities
Commitment to continuous process improvement
Exceptional verbal and written communication skills
Demonstrated successful relationship building
Experience working with cross-functional business areas

Responsibilities

Serves as subject matter expert on National Committee for Quality Assurance (NCQA) Health Plan Accreditation and Long-Term Services and Supports (LTSS) requirements, advising stakeholders on compliance, and facilitating NCQA LTSS file universe preparation and LTSS file reviews
Works closely with operational areas to prepare documentation and files for presentation to NCQA
Advises operational leaders and frontline associates in developing functional strategies for compliance with accreditation standards
Self-directed, exercises independent judgement and decision-making on complex issues regarding job duties and related tasks, and works under minimal supervision
Uses independent judgement requiring analysis of variable factors and determining the best course of action

Skills

Humana

Health insurance provider for seniors and military

About Humana

Humana provides health and well-being services, focusing on Medicare Advantage plans for seniors, military personnel, and communities. Their plans include HMO, PPO, and PFFS options, designed to improve health outcomes through comprehensive and flexible coverage. Humana's revenue comes from government contracts and member premiums, and they aim to maintain high renewal rates by offering quality service and competitive benefits. The company stands out by fostering a culture of inclusivity and belonging among its employees, while also ensuring accessibility for all members, including offering free language interpreter services. Humana's goal is to deliver value to its members through an extensive provider network and innovative health solutions.

Louisville, KentuckyHeadquarters

1961Year Founded

IPOCompany Stage

Social Impact, HealthcareIndustries

10,001+Employees

Risks

Potential over-reliance on AI could disrupt operations if systems fail or are compromised.

Rising medical costs and tightening Medicare reimbursements may strain financial performance.

Leadership change with new CEO Jim Rechtin could lead to strategic disruptions.

Differentiation

Humana is a leader in Medicare Advantage plans, focusing on seniors and military personnel.

The company emphasizes inclusivity, offering free language interpreter services for accessibility.

Humana leverages AI and cloud technologies through a partnership with Google Cloud.

Upsides

Humana's investment in Healthpilot enhances digital enrollment for Medicare options.

The company is the first insurer to cover TMS therapy for adolescent depression.

Humana's focus on value-based care aims to improve outcomes for kidney disease patients.

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