Senior Accreditation Professional

San Antonio, Texas, United States

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Not SpecifiedCompensation

Senior (5 to 8 years)Experience Level

Full TimeJob Type

UnknownVisa

Health Insurance, HealthcareIndustries

Requirements

Candidates must possess a Bachelor's Degree or BSN degree and at least 3 years of experience in NCQA Health Plan Accreditation and/or Medicaid Module. Exceptional analytical, critical thinking, problem-solving, and attention to detail skills are required, along with demonstrated excellent time management, flexibility, and ability to handle multiple tasks and deadlines. Strong verbal and written communication skills, successful relationship building experience, and experience working with cross-functional business areas are also necessary. Managed care and Medicaid health plan experience, as well as an advanced degree in a healthcare-related field, are preferred.

Responsibilities

The Senior Accreditation Professional will serve as a subject matter expert on NCQA Health Plan Accreditation Member Experience and Medicaid Module requirements, advising stakeholders on compliance. This role involves working closely with operational areas to prepare documentation and files for NCQA presentations and advising leaders and associates in developing functional strategies for compliance. The professional will exercise independent judgment and decision-making on complex issues with minimal supervision and is committed to continuous process improvement.

Skills

NCQA Health Plan Accreditation

Medicaid Module

Accreditation Standards

Analytical Skills

Critical Thinking

Problem Solving

Time Management

Process Improvement

Communication Skills

Relationship Building

Managed Care

Medicaid Health Plan

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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