Senior Quality Compliance Professional

Job Overview Become a part of our caring community The Senior Quality Compliance Professional supports quality improvement, regulatory compliance, and performance oversight activities for Humana's Louisiana health plan operations. You will evaluate, monitor and support compliance with applicable state, federal, contractual, accreditation, and internal quality requirements. The Senior Quality Compliance Professional will collaborate with Quality Improvement, Clinical Operations, Compliance, Provider Engagement, Network, Population Health, and other cross-functional partners. This collaboration will support quality initiatives, audit readiness, corrective action management, regulatory reporting, and performance improvement activities. We ask that you have an active Registered Nurse license and residency in Louisiana. You will also have familiarity with the MCIP program through the Louisiana Department of Health and an understanding of Louisiana Medicaid quality expectations. Support quality compliance activities related to Louisiana Medicaid managed care requirements, Humana policies, regulatory expectations, and contractual obligations. Monitor, review, and evaluate quality-related processes, documentation, reports, and operational workflows to identify compliance risks, performance gaps, and improvement opportunities. Support activities related to the MCIP program through the Louisiana Department of Health, including quality monitoring, documentation review, program support, and cross-functional coordination. Support the preparation, coordination, and response activities for audits, reviews, readiness assessments, state inquiries, and internal compliance evaluations. Track and support corrective action plans, including issue identification, root cause review, action plan development, evidence collection, follow-up, and validation of remediation. Partner with internal stakeholders to ensure that you implement quality initiatives and compliance activities consistently and aligned with applicable Louisiana Medicaid requirements. Analyze clinical, operational, and quality performance data to identify trends, gaps, and potential areas of risk. Prepare summaries, reports, presentations, and status updates for leadership and business partners. Provide subject matter support regarding clinical quality standards, documentation expectations, compliance processes, and state-specific quality initiatives. Maintain current knowledge of Louisiana Department of Health requirements, Medicaid managed care quality expectations, regulatory guidance, accreditation standards, and Humana internal policies. Support continuous improvement activities that improve quality outcomes, member experience, regulatory performance, and operational effectiveness. Collaborate with provider-facing and clinical teams to support quality improvement interventions and compliance-related education, as needed. Participate in internal and external meetings, workgroups, and committees related to Louisiana quality improvement and compliance activities. Use your skills to make an impact. Required Qualifications Active, unrestricted Registered Nurse license in Louisiana, or active RN license with eligibility to practice in Louisiana in accordance with applicable licensure requirements and Humana policy. Must reside in Louisiana. Bachelor's degree in nursing. Familiarity with the MCIP program through the Louisiana Department of Health. Three or more years of experience in one or more of the following areas: Healthcare quality improvement Quality compliance Medicaid managed care Case management Population health Experience interpreting and applying healthcare policies, procedures, regulatory requirements, contractual requirements, or accreditation standards. Strong understanding of clinical documentation, quality monitoring, compliance follow-up, and performance improvement processes. Analyze data, identify trends, summarize findings, and recommend appropriate actions. Demonstrated ability to work independently, manage multiple priorities, meet deadlines, and collaborate across teams. Preferred Qualifications Experience working with Louisiana Medicaid managed care programs. Experience supporting quality initiatives for a Medicaid managed care organization. Knowledge of Louisiana Department of Health quality programs, reporting expectations, and performance improvement initiatives. Experience with audit readiness, corrective action plans, quality monitoring, and regulatory reporting. Experience with HEDIS, CAHPS, NCQA, CMS quality programs, state quality measures, or Medicaid quality improvement projects. Experience working in a matrixed managed care or health plan environment. Additional Information Section 1121 of the Louisiana Code of Governmental Ethics states that current or former agency heads or elected officials, board or commission members or public employees of the Louisiana Health Department (LDH) who work directly with LDH’s Medicaid Division cannot be considered for this opportunity. A separation of two (2) or more years from LDH is required for consideration. Work from 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. Benefits 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. About Us Humana Inc. (NYSE: HUM) is a leading U.S. healthcare company. Through our Humana insurance services and our 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 and Medicaid, families, individuals, military service personnel, and communities at large. Learn more about what we offer at Humana.com and at CenterWell.com. 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. #J-18808-Ljbffr Humana Inc