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Humana Healthy Horizons is seeking an Accreditation Manager who will oversee and support a team of accreditation professionals who perform complex tasks related to compliance with accreditation standards across multiple operational areas and lines of business within Humana. The Accreditation Manager will ensure progress is made toward achieving and maintaining Humana’s health plan accreditations for Medicare and Medicaid.

The Accreditation Manager’s roles and responsibilities include but are not limited to:

• Manages a team of accreditation professionals – includes hiring, training, problem solving, coaching, and general support.

• Serves as subject matter expert on NCQA Health Plan Accreditation requirements and advising team and other operational areas on compliance.

• Leads direct reports in working closely with operational areas to prepare documentation for submission to NCQA.

• Advises operational leaders and frontline associates in developing functional strategies for compliance with accreditation standards.

• Oversees internal NCQA Health Plan Accreditation survey tracking tools to ensure progress is made and risks are mitigated in a timely fashion.

• Responds to requests for proposals related to accreditation requirements.

• Conducts quality reviews of all accreditation survey evidence created by direct reports prior to submission to NCQA.

• Exercises independent judgement and decision-making on complex issues regarding job duties and related tasks and works under minimal supervision (self-directed).

• Uses independent judgement requiring analysis of variable factors and determining the best course of action.

Use your skills to make an impact

Required Qualifications

• Bachelor’s Degree or BSN degree.

• 5+ years of experience in NCQA Health Plan Accreditation.

• 2+ years of experience with continuous process improvement.

• Exceptional analytical and critical thinking skills, including problem solving and proficiency in executing solutions.

• Demonstrated excellent skills in project and time management with proven ability to be flexible, adapt to changing environment, handle multiple tasks and deadlines and manage multiple priorities.

• Exceptional verbal and written communication skills.

• Demonstrated successful relationship building and experience working with cross-functional business areas.

Preferred Qualifications

• Experience in managing a team.

• Registered Nurse or Behavioral Health professional.

• Managed care, Medicaid health plan experience.

• Advanced degree in a healthcare-related field.

Work From Home

To ensure Home or Hybrid Home/Office employees’ ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office employees must meet the following criteria:

At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is recommended; wireless, wired cable or DSL connection is suggested. Satellite, cellular and microwave connection can be used only if approved by leadership

Employees who live and work from Home in the state of California, Illinois, Montana, or South Dakota will be provided a bi-weekly payment for their internet expense.

Humana will provide Home or Hybrid Home/Office employees with telephone equipment appropriate to meet the business requirements for their position/job. Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information.

Additional Information:

• Workstyle: Remote – work at home.

• Direct Reports: 6

• Location: Nationwide United States.

• Travel: Less than 5% travel - typically 1-3 times annually, possibly outside of your state of residence, for team engagement meetings, onsite audits, and trainings.

• Core Workdays & Hours: Typically, Monday – Friday; 8:00am – 5:00pm Central or Eastern Standard Time (EST).

• Benefits: Benefits are effective on day 1. Full time Associates enjoy competitive pay and a comprehensive benefits package that includes 401k, Medical, Dental, Vision and a variety of supplemental insurances, tuition assistance and much more.....

Interview Format

As part of our hiring process, we will be using an exciting interviewing technology provided by Hire Vue, a third-party vendor. This technology provides our team of recruiters and hiring managers an enhanced method for decision-making.

If you are selected to move forward from your application prescreen, you will receive correspondence inviting you to participate in a pre-recorded Voice Interview and/or an SMS Text Messaging interview. If participating in a pre-recorded interview, you will respond to a set of interview questions via your phone. You should anticipate this interview to take approximately 10-15 minutes.

If participating in a SMS Text interview, you will be asked a series of questions to which you will be using your cell phone or computer to answer the questions provided. Expect this type of interview to last anywhere from 5-10 minutes. Your recorded interview(s) via text and/or pre-recorded voice will be reviewed, and you will subsequently be informed if you will be moving forward to next round of interviews.

Scheduled Weekly Hours

40

Pay Range

The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc.

$94,900 - $130,500 per year

This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance.

Description of Benefits

Humana, Inc. and its affiliated subsidiaries (collectively, “Humana”) offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.

Application Deadline: 01-30-2025

About us

Humana Inc. (NYSE: HUM) is committed to putting health first – for our teammates, our customers and our company. Through our Humana insurance services and CenterWell healthcare services, we make it easier for the millions of people we serve to achieve their best health – delivering the care and service they need, when they need it. These efforts are leading to a better quality of life for people with Medicare, Medicaid, families, individuals, military service personnel, and communities at large.

Equal Opportunity Employer

It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or veteran status. It is also the policy of Humana to take affirmative action to employ and to advance in employment, all persons regardless of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment.

Humana complies with all applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, sex, sexual orientation, gender identity or religion. We also provide free language interpreter services. See our https://www.humana.com/legal/accessibility-resources?source=Humana_Website.