Remote QA & Compliance Manager, LTSS Oversight

Humana

United States

Remote

USD 90,000 - 115,000

Full time

5 days ago

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Job summary

Humana seeks a Manager, Quality Assurance for the External LTSS Oversight Team to lead QA professionals ensuring LTSS eligibility and service authorization compliance. You will coordinate with Area Agencies on Aging and other partners, guiding daily operations and policy development while maintaining cross‑department collaboration.

The role requires Michigan residency, RN or LBSW licensure, and 3+ years in complex populations with 2+ years in management.

Qualifications

Must reside in Michigan.
Active, unrestricted licensed RN or LBSW in Michigan.
3+ years of experience with complex populations, home and community-based services or managed care.
2+ years of management or supervisory experience.
Proficiency with Microsoft Office applications, including Excel and PowerPoint.
Proficiency in analyzing and interpreting data trends.
Excellent oral and written communication and interpersonal skills.
Care Management certification (CCM) preferred.
3+ years of managed care experience (Medicare/Medicaid) preferred.
Bilingual or multilingual abilities (English/Spanish, Arabic, etc.) preferred.

Responsibilities

Oversee the External Oversight Team and monitor compliance to HCBS eligibility and service authorization metrics.
Plan and oversee daily operations of the team and allocate resources for projects.
Collaborate with internal Humana departments and external stakeholders.
Develop policies and procedures to ensure state and federal compliance and share best practices.
Provide real-time training to downstream entities on ongoing compliance requirements.