Senior Accreditation Professional

Humana Inc; Montana; Remote; USD 78,000 - 108,000; Full time

Job summary

Join Humana Inc. as a Senior Accreditation Professional in a remote role focused on health plan compliance with NCQA standards. You will leverage your expertise to guide various operational teams while contributing to quality improvement initiatives in healthcare delivery. This role requires strong analytical capability, attention to detail, and exceptional communication skills to foster relationships across business functions. Enjoy flexibility, with opportunities for occasional travel, while making a substantial impact on health outcomes for our communities.

Qualifications

• Three years of experience in NCQA Health Plan Accreditation focusing on Credentialing Accreditation.
• Prior experience with NCQA surveys, strong relationship building with cross-functional teams.

Responsibilities

• Serve as subject matter expert on NCQA Health Plan Accreditation.
• Prepare documentation for NCQA and advise on compliance strategies.

Skills

Analytical skills

Critical thinking skills

Time management

Communication skills

Education

Bachelor's degree

Tools

Credentials Verification Organization (CVO) Certification

Healthcare-related degree (advanced)

Job description

Job Profile

Senior Accreditation Professional

Job Level

Senior Professional

Become a part of our caring community and help us put health first

We are seeking a Senior Accreditation Professional who will work in a team environment on Humana’s health plan accreditations, performing complex tasks related to compliance with accreditation standards across multiple operational areas within Humana.

Role Responsibilities:

• Serves as subject matter expert on National Committee for Quality Assurance (NCQA) Health Plan Accreditation Credentialing (CR) requirements and advising stakeholders on compliance.
• Works closely with operational areas to prepare documentation for submission to NCQA.
• Advises operational leaders and frontline associates in developing functional strategies for compliance with accreditation standards.
• Self-directed, exercises independent judgement and decision-making on complex issues regarding job duties and related tasks, and works under minimal supervision.
• Uses independent judgement requiring analysis of variable factors and determining the best course of action.

Use your skills to make an impact

Required Qualifications

• Bachelor's degree.
• Three (3) years of experience in NCQA Health Plan Accreditation with a focus on Credentialing Accreditation.
• Prior experience participating in NCQA virtual or onsite surveys.
• Commitment to continuous process improvement.
• Exceptional analytical and critical thinking skills, including problem solving and proficiency in executing solutions.
• Exceptional attention to detail.
• Demonstrated excellent time management skills with proven ability to be flexible, adapt to changing environment, handle multiple tasks and deadlines and manage multiple priorities.
• Exceptional verbal and written communication skills.
• Demonstrated successful relationship building.
• Experience working with cross-functional business areas.

Preferred Qualifications

• Credentials Verification Organization (CVO) Certification.
• Registered Nurse or Behavioral Health professional.
• Advanced degree in a healthcare-related field.
• Managed care, Medicaid health plan experience.

Additional Information

• Workstyle: This is a remote position with some travel.
• Schedule: Monday through Friday; 8:00 AM – 5:00 PM Eastern Standard Time (EST). Must be able to accommodate work schedules and meetings in both Central and Eastern time zones.
• Travel: Up to 5% travel – typically, 3-5 times annually possibly outside of your state of residence for team engagement meetings, onsite audits, and trainings.

WAH Internet Statement

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.
• Satellite, cellular and microwave connection can be used only if approved by leadership.
• Employees who live and work from Home in the state of California, Illinois, Montana, or South Dakota will be provided a bi-weekly payment for their internet expense.
• Humana will provide Home or Hybrid Home/Office employees with telephone equipment appropriate to meet the business requirements for their position/job.
• Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information.

Interview Format

As part of our hiring process for this opportunity, we will be using an interviewing technology called HireVue to enhance our hiring and decision-making ability. HireVue allows us to quickly connect and gain valuable information from you pertaining to your relevant skills and experience at a time that is best for your schedule.

Travel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be required.

Scheduled Weekly Hours

40

Pay Range

The 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.$78,400 - $107,800 per yearThis job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance.

Referral Bonus Information

This requisition is not eligible for a referral bonus.Application Deadline: 09-04-2025

About us

Humana Inc. (NYSE: HUM) is committed to putting health first – for our teammates, our customers and our company. Through our Humana insurance services and CenterWell healthcare services, we make it easier for the millions of people we serve to achieve their best health – delivering the care and service they need, when they need it. These efforts are leading to a better quality of life for people with Medicare, Medicaid, families, individuals, military service personnel, and communities at large.

Equal Opportunity Employer

It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status. It is also the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and VEVRAA, to employ and to advance in employment individuals with disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment.