The Senior Quality Assurance Professional is responsible for leading organizational quality initiatives with a primary focus on achieving and maintaining NCQA Credentialing Accreditation.
This role serves as the subject matter expert for accreditation standards, credentialing quality processes, and continuous improvement efforts. The Senior Quality Assurance Professional partners closely with Credentialing, Quality, Compliance, and Operations leadership to ensure adherence to regulatory, accreditation, and organizational requirements.
In addition to leading accreditation readiness activities, this position supports quality metric tracking, reporting, auditing, and improvement initiatives. The role may also provide operational support to the Compliance department during periods of increased regulatory activity or audit preparation.
Key Responsibilities:- Lead NCQA Credentialing Accreditation preparation, submission, and maintenance activities.
- Conduct accreditation readiness assessments and implement corrective action plans.
- Develop, review, and maintain policies, procedures, and supporting documentation.
- Partner with the Quality Lead to track, analyze, and report quality metrics.
- Perform audits, quality reviews, and process improvement activities.
- Support regulatory audits and compliance initiatives as needed.
- Collaborate with operational and leadership teams to ensure ongoing compliance with accreditation and quality standards.
Required Qualifications:- Bachelor's degree or equivalent experience in healthcare, quality, business, or a related field.
- 5+ years of experience in healthcare quality, accreditation, credentialing, or compliance.
- Experience with NCQA standards and accreditation processes strongly preferred.
- Strong analytical, project management, and communication skills.
Work at Home Requirements: 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 required; wireless, wired cable or DSL connection is suggested. In certain roles, the minimum recommended internet speed required by Humana may not be sufficient for business needs. Humana reserves the right to require associates to upgrade their internet service if necessary. Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information.
Travel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be required.
Scheduled Weekly Hours40
Pay RangeThe 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.
$86,200 - $118,600 per year
This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance.
Description of BenefitsHumana, 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, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.
