Senior Quality Compliance Professional

🔥 0 minutes ago

⚜️ Louisiana – Remote

⚜️ Louisiana – Remote

💵 $78.4k - $107.8k / year

⏰ Full Time

🟠 Senior

🚔 Compliance

🦅 H1B Visa Sponsor

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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

• Support quality improvement, regulatory compliance, and performance oversight for Humana's Louisiana health plan operations • Support quality compliance activities related to Louisiana Medicaid managed care requirements, Humana policies, regulatory expectations, and contractual obligations • Monitor, review, and evaluate quality processes, documentation, reports, and operational workflows • Identify compliance risks, performance gaps, and improvement opportunities • Support the MCIP program through quality monitoring, documentation review, program support, and cross-functional coordination • Prepare, coordinate, and respond to audits, reviews, readiness assessments, state inquiries, and internal compliance evaluations • Track and support corrective action plans, including root cause review, action plan development, evidence collection, follow-up, and remediation validation • Implement quality initiatives and compliance activities aligned with Louisiana Medicaid requirements • Analyze clinical, operational, and quality performance data • Prepare summaries, reports, presentations, and status updates for leadership and business partners • Provide subject matter support on clinical quality standards, documentation expectations, compliance processes, and state-specific quality initiatives • Maintain knowledge of Louisiana Department of Health requirements, Medicaid quality expectations, regulatory guidance, accreditation standards, and Humana policies • Support continuous improvement activities affecting quality outcomes, member experience, regulatory performance, and operational effectiveness • Collaborate with provider-facing and clinical teams on quality improvement interventions and compliance education • Participate in meetings, workgroups, and committees related to Louisiana quality improvement and compliance activities

🎯 Requirements

• Active, unrestricted Registered Nurse license in Louisiana, or active RN license with eligibility to practice in Louisiana • Must reside in Louisiana • Bachelor's degree in nursing • Familiarity with the MCIP program through the Louisiana Department of Health • Three or more years of experience in healthcare quality improvement, quality compliance, Medicaid managed care, case management, or population health • Experience interpreting and applying healthcare policies, procedures, regulatory requirements, contractual requirements, or accreditation standards • Strong understanding of clinical documentation, quality monitoring, compliance follow-up, and performance improvement processes • Ability to analyze data, identify trends, summarize findings, and recommend appropriate actions • Ability to work independently, manage multiple priorities, meet deadlines, and collaborate across teams • Proficiency with Microsoft Office • Section 1121 eligibility restriction: current or former LDH agency heads, elected officials, board or commission members, or public employees working directly with LDH’s Medicaid Division require a separation of two or more years from LDH for consideration

🏖️ 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 • Dedicated workspace and internet requirements for effective home working