Quality Assurance Professional

🔥 18 hours ago

🏈 Ohio, Michigan – Remote

🏈 Ohio – Remote 🚗 Michigan – Remote

💵 $65k - $88.6k / year

⏰ Full Time

🟢 Junior

🟡 Mid-level

🔧 QA Engineer (Quality Assurance)

🦅 H1B Visa Sponsor

This company has sponsored H1B visas in the past.

👻 Ghost score 0%

What it means: how likely this posting is sitting open without active hiring.How to read it: 60% or higher means we think this is a ghost. Lower scores are less of a worry.How we score it: age, reposts, open roles vs team size, how fast jobs close, and whether pay is listed.Fine print: an estimate from public data, not a judgment of the company. Real jobs can score high, so treat it as a hint, not a fact.

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Humana

WebsiteLinkedInAll Job Openings

10,000+ employees

Founded 1961

🏥 Healthcare

🛡️ Insurance

⚕️ Healthcare Insurance

Healthcare • Insurance • Healthcare Insurance

Humana is a healthcare company dedicated to making a positive impact on the health of individuals, communities, and the healthcare system as a whole. With a focus on putting health first, Humana serves a diverse range of populations, including seniors and the military, providing Medicare Advantage HMO, PPO, and PFFS plans. Humana is committed to fostering a culture of belonging and mutual respect, offering competitive and flexible benefits to ensure the financial security of its employees and their families. The company prides itself on creating an inclusive workplace where everyone has the opportunity to succeed.

📋 Description

• Review LTSS contractor documentation and performance for compliance with contract scope of work and state and federal regulations • Ensure adherence to policies, procedures, and regulations and prevent and detect fraud, waste, and abuse • Conduct and summarize compliance audits and reports, including deficiencies and risks • Collect and review records, summarize issues, and analyze data to assess outcome and operational metrics • Conduct inter-rater reliability audits for vendor activities, including HCBS service calculators and nursing facility level of care determination assessments • Ensure MDHHS, NCQA, CMS, and Humana Gold-Plus Integrated policies and procedures are followed • Complete audits timely and communicate findings to leadership • Make decisions regarding work methods in occasionally ambiguous situations with minimal direction • Perform other duties as assigned by the LTSS leadership team • Travel occasionally to Humana offices for training, meetings, audits, accreditation-related activities, and team engagement meetings

🎯 Requirements

• Must reside in Michigan or within a 40-mile radius of the Michigan border in Ohio or Indiana • Bachelor's degree • Two (2) or more years of experience in care management, utilization management, quality assurance and/or population health supporting the Long-Term Services and Supports (LTSS) population • Previous experience working with Managed Care Organization • Proficiency in analyzing, tracking, and interpreting data trends to identify improvement opportunities and ensure adherence to operational guidelines, policies, and procedures • Proficient with Microsoft Office products including Word, Excel, PowerPoint, and Outlook • Licensed healthcare professional in the state of Michigan: LPN, RN, LMSW, LBSW (preferred) • Previous Medicare/Medicaid, MDHHS, CMS, and NCQA experience (preferred) • Minimum download speed of 25 Mbps and upload speed of 10 Mbps for self-provided internet service • Dedicated workspace without ongoing interruptions to protect member PHI/HIPAA information

🏖️ Benefits

• Bonus incentive plan based on company and/or individual performance • Medical benefits • Dental benefits • Vision benefits • 401(k) retirement savings plan • Paid time off • Company holidays • Personal holidays • Paid parental leave • Paid caregiver leave • Short-term disability • Long-term disability • Life insurance • Remote work • Dedicated home workspace requirements to protect member PHI/HIPAA information