Remote QA Manager – LTSS Compliance & Oversight

Humana Inc; Lansing (MI); Remote; USD 104,000 - 143,000; Full time

Benefits offered by this job

Bonus incentive plan

Job summary

Humana Inc. is seeking a Manager of Quality Assurance for the External LTSS Oversight Team. You will lead QA professionals ensuring LTSS eligibility determination and service authorization meet Humana and state requirements.

You’ll collaborate with Area Agencies on Aging and other external partners, guiding day-to-day operations and policy development. The role requires a Michigan-licensed RN or LBSW, 3+ years of relevant experience, and 2+ years of management.

Qualifications

• Must reside in Michigan.
• Active, unrestricted licensed RN or Licensed Social Worker (LBSW, LLMSW, LMSW) in Michigan.
• 3+ years of professional experience with complex populations, home and community-based services, or managed care.
• 2+ years of management or supervisory experience.
• Proficiency in Microsoft Office applications, including Excel and PowerPoint.
• Strong ability to analyze data trends and communicate findings effectively.

Responsibilities

• Oversee the External Oversight Team and monitor LTSS compliance and operational metrics.
• Plan and oversee daily operations, allocating resources for projects and cross-department initiatives.
• Conduct briefings and maintain regular contact with internal and external stakeholders.
• Liaise with external partners such as Area Agencies on Aging (AAA) and vendors.
• Develop policies to ensure compliance with state and federal requirements.
• Provide real-time training and re-training on ongoing compliance requirements and policies.

Skills

Data analysis

Communication skills

Leadership

Microsoft Office (Excel, PowerPoint)

Education

RN or LBSW licensure (Michigan)

Tools

Microsoft Excel

PowerPoint

Job description

Humana Inc. is seeking a Manager of Quality Assurance for the External LTSS Oversight Team. You will lead QA professionals ensuring LTSS eligibility determination and service authorization meet Humana and state requirements.

You’ll collaborate with Area Agencies on Aging and other external partners, guiding day-to-day operations and policy development. The role requires a Michigan-licensed RN or LBSW, 3+ years of relevant experience, and 2+ years of management.