Manager, Quality Assurance – LTSS

Humana

. Lead the External LTSS Oversight Team of Quality Assurance professionals and Care Management Support Assistants .

Posted 10/21/2026full-timeMichigan • United StatesMid-LevelSenior💰 $104,000 - $143,000 per yearWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates expertise in managing quality assurance and care management teams while ensuring compliance with state and federal LTSS requirements. Proficient in data analysis, policy development, and effective communication with diverse stakeholders.

Highest-signal resume keywords

Registered Nurse (RN) LicenseManagement ExperienceCare Management Certification (CCM)Data Analysis ProficiencyManaged Care Experience

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

LTSS Eligibility DeterminationService AuthorizationUtilization ManagementDischarge PlanningHome Health ExperienceRehabilitation ExperienceFinancial Trend AnalysisPolicy DevelopmentOperational Metrics MonitoringService Plan Initiation

Soft Skills

Exceptional Oral CommunicationExceptional Written CommunicationInterpersonal SkillsTeam CollaborationTraining and Retraining Skills

Tools & Technologies

Microsoft OfficeExcelPowerPoint

Certifications & Qualifications

Registered Nurse (RN)Licensed Social Worker (LBSW, LLMSW, LMSW)Care Management Certification (CCM)

Industry Keywords

Home and Community-Based ServicesManaged CareMedicareMedicaidLTSSHealth PromotionDisease ManagementQuality AssuranceArea Agencies on AgingBilingual Proficiency

About the role

Key responsibilities & impact

Lead the External LTSS Oversight Team of Quality Assurance professionals and Care Management Support Assistants
Ensure consistency and compliance with state and Humana requirements for LTSS eligibility determination and service authorization
Monitor HCBS eligibility determination, service authorization, LTSS compliance, and operational metrics
Plan and oversee daily team operations, resources, projects, and initiatives
Collaborate across departments and with external partners, vendors, and Area Agencies on Aging
Conduct briefings and area meetings with internal and external stakeholders
Develop policies and procedures aligned with state and federal requirements and industry best practices
Provide real-time training and retraining to downstream entities
Support department and market goals
Participate in interdisciplinary team meetings
Travel occasionally to Humana's Detroit office for team engagement, collaboration, training, or meetings

Requirements

What you’ll need

Must reside in Michigan
Active, unrestricted Registered Nurse (RN) or Licensed Social Worker (LBSW, LLMSW, LMSW) license in Michigan
Three or more years of professional experience working with complex populations, home and community-based services, or managed care settings
Two 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
Preferred: Care Management certification (CCM)
Preferred: Three or more years of managed care experience in Medicare and/or Medicaid, including LTSS, hospice, or nursing facilities
Preferred: Proficiency in analyzing and interpreting financial trends
Preferred: Experience in utilization management, discharge planning, home health, or rehabilitation
Preferred: Experience initiating service plans for members
Preferred: Experience with disease management, health promotion, coaching, and wellness
Preferred: Health Plan experience
Preferred: Bilingual or multilingual ability, including English/Spanish, Arabic, Chaldean Neo-Aramaic, or other languages, with speaking, reading, and writing proficiency

Benefits

Comp & perks

Bonus incentive plan based on company and/or individual performance
Medical, dental, and vision benefits
401(k) retirement savings plan
Paid time off
Company and personal holidays
Paid parental and caregiver leave
Short-term and long-term disability
Life insurance
Remote work arrangement
Work-from-home setup with dedicated workspace and required internet connectivity