Senior Accreditation Professional

Senior Accreditation Professional

Become a part of our caring community. We are looking for 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.

Responsibilities include:

• Serve as subject matter expert on National Committee for Quality Assurance (NCQA) Health Plan Accreditation and Long-Term Services and Supports (LTSS) requirements, advising stakeholders on compliance, and facilitating NCQA LTSS file universe preparation and LTSS file reviews.
• Work with operational areas to prepare documentation and files for presentation to NCQA.
• Advise operational leaders in developing functional strategies for compliance with accreditation standards.
• Perform complex duties and responsibilities with minimal supervision, using independent judgment, critical thinking, and sound decision-making to resolve issues and achieve business objectives.
• Use 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.
• Minimum three (3) years of experience in NCQA Health Plan Accreditation.
• Experience collaborating effectively with cross-functional business areas to achieve organizational goals, drive initiatives, and support business objectives.
• Experience analyzing data to identify issues, evaluate alternatives, solve complex problems, and implement effective solutions that support business objectives and drive operational improvements.
• Demonstrate strong verbal and written communication skills, with the ability to clearly, professionally, and effectively convey information to diverse audiences and partners.

Preferred Qualifications:

• Current, active, and unrestricted licensure as a Registered Nurse (RN) or Behavioral Health Professional.
• Expertise in NCQA accreditation standards, particularly LTSS requirements.
• Experience with Medicare and Medicaid health plans, with specific expertise in Dual Eligible Special Needs Plans (D-SNP).
• Experience conducting research and applying investigative skills to identify issues, analyze findings, and support informed decision-making.

Additional Information:

• Workstyle: This is a remote position with some travel.
• Travel: Up to 5% travel, typically 3 to 5 trips annually, which may include travel outside your state of residence for team engagement meetings, onsite audits, and training sessions.
• Work Schedule: Monday through Friday, 8:00 AM to 5:00 PM Eastern Time (ET). You will be expected to accommodate work schedules and meetings across both Eastern and Central time zones.

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

Hours:

40

Pay Range: $78,400 - $107,800 per year

This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance.

Description of Benefits:
Humana, 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.

Final date to receive applications: 12-01-2026

About Humana:
Humana Inc. (NYSE: HUM) is a leading U.S. healthcare company. Through our Humana insurance services and our Center Well healthcare…