Manager, Quality Assurance (LTSS)

Become a part of our caring community   Humana is seeking a Manager, Quality Assurance (External LTSS Oversight Team Manager) who will lead a team of Quality Assurance Professionals responsible for ensuring consistency of use and compliance to state and Humana requirements for Long-Term Services and Supports (LTSS) eligibility determination and service authorization. You will collaborate with external partners such as Area Agencies on Aging (AAA) and assist with monitoring day-to-day operational activities with AAAs and other external LTSS partners. You will work within specific guidelines and procedures; applies advanced technical knowledge to solve moderately complex problems; receive assignments in the form of objectives and determine approach, resources, schedules, and goals. • Oversee the External Oversight Team (Quality Assurance professionals and Care Management Support Assistants) staff and monitors compliance to HCBS eligibility determination, service authorization, and other key LTSS compliance or operational metrics as identified. • Responsible for planning and overseeing daily operations of team. This includes making decisions related to resources and approach for projects and initiatives involving own departmental area and requires cross departmental collaboration. • Conduct briefings, area meetings, and maintains frequent contact with internal and external stakeholders such as other Humana departments. • Liaise and maintain frequent contact with external stakeholders and vendors such as Area Agencies on Aging, conducts briefings and area meetings, • Develop policies and procedures to ensure compliance with state and federal requirements and incorporate industry best practices. • Provide real-time training/re-training to downstream entities on ongoing compliance requirements, policies, and procedures. • Support leadership in meeting goals of the department/market. • May participate in Interdisciplinary team meetings. Use your skills to make an impact   Required Qualifications • Must reside in Michigan. • An active, unrestricted licensed Registered Nurse (RN) or Licensed Social Worker (LBSW, LLMSW, LMSW) in the state of Michigan. • Three (3) or more years of professional experience working with complex populations, home and community-based services or in managed care settings. • Two (2) or more years of management or supervisory experience. • Comprehensive knowledge of Microsoft Office applications, including Excel, and PowerPoint. • Proficiency in analyzing and interpreting data trends. • Exceptional oral and written communication and interpersonal skills with the ability to quickly build rapport. Preferred Qualifications • Care Management certification (CCM). • Three (3) or more years of managed care experience in Medicare and/or Medicaid, specifically in the delivery of care for elderly or special needs populations such as the Aged, Blind and Disabled (ABD) and those enrolled in Long-Term Services and Supports (LTSS) Waiver Services, in hospice and/or in nursing facilities. • Proficiency in analyzing and interpreting financial trends. • Previous experience in utilization management, discharge planning and/or home health or rehabilitation. • Experience with initiating service plans for members. • Experience with disease management, health promotion, coaching and wellness. • Health Plan experience. • Bilingual or Multilingual: English/Spanish, Arabic, Chaldean Neo-Aramaic, or other - Must be able to speak, read and write in both languages without limitations and assistance (see Additional Information for more information on language proficiency assessments). Additional Information • Workstyle: This is a remote position that requires some travel. • Travel: Up to 25% travel to Humana's Detroi