Quality Assurance Professional

Humana

. Review LTSS contractor documentation and performance for compliance with contract scope of work and state and federal regulations .

Posted 10/20/2026full-timeRemote • United StatesJuniorMid-Level💰 $65,000 - $88,600 per yearWebsite

Core Competencies

Role fit

Core Competencies

Use this summary to align your resume positioning with the role.

Demonstrates expertise in compliance auditing, data analysis, and adherence to healthcare regulations, particularly within Long-Term Services and Supports (LTSS). Proficient in managing operational metrics and ensuring quality assurance in care management settings.

Highest-signal resume keywords

Compliance AuditingData AnalysisLong-Term Services And Supports (LTSS)Managed Care Organization ExperienceLicensed Healthcare Professional

ATS Keywords

Tailor your resume

Applicant Tracking System Keywords

Tip: use these terms in your resume and cover letter to boost ATS matches.

Hard Skills

Data InterpretationQuality AssuranceUtilization ManagementCare ManagementOperational Guidelines Adherence

Soft Skills

CommunicationDecision-MakingProblem-Solving

Tools & Technologies

Microsoft OfficeExcelWordPowerPointOutlook

Certifications & Qualifications

LPNRNLMSWLBSW

Industry Keywords

MedicareMedicaidMDHHSCMSNCQA

About the role

Key responsibilities & impact

Review LTSS contractor documentation and performance for compliance with contract scope of work and state and federal regulations
Ensure adherence to policies, procedures, and regulations and prevent and detect fraud, waste, and abuse
Conduct and summarize compliance audits and reports, including deficiencies and risks
Collect and review records, summarize issues, and analyze data to assess outcome and operational metrics
Conduct inter-rater reliability audits for vendor activities, including HCBS service calculators and nursing facility level of care determination assessments
Ensure MDHHS, NCQA, CMS, and Humana Gold-Plus Integrated policies and procedures are followed
Complete audits timely and communicate findings to leadership
Make decisions regarding work methods in occasionally ambiguous situations with minimal direction
Perform other duties as assigned by the LTSS leadership team
Travel occasionally to Humana offices for training, meetings, audits, accreditation-related activities, and team engagement meetings

Requirements

What you’ll need

Must reside in Michigan or within a 40-mile radius of the Michigan border in Ohio or Indiana
Bachelor's degree
Two (2) or more years of experience in care management, utilization management, quality assurance and/or population health supporting the Long-Term Services and Supports (LTSS) population
Previous experience working with Managed Care Organization
Proficiency in analyzing, tracking, and interpreting data trends to identify improvement opportunities and ensure adherence to operational guidelines, policies, and procedures
Proficient with Microsoft Office products including Word, Excel, PowerPoint, and Outlook
Licensed healthcare professional in the state of Michigan: LPN, RN, LMSW, LBSW (preferred)
Previous Medicare/Medicaid, MDHHS, CMS, and NCQA experience (preferred)
Minimum download speed of 25 Mbps and upload speed of 10 Mbps for self-provided internet service
Dedicated workspace without ongoing interruptions to protect member PHI/HIPAA information

Benefits

Comp & perks

Bonus incentive plan based on company and/or individual performance
Medical benefits
Dental benefits
Vision benefits
401(k) retirement savings plan
Paid time off
Company holidays
Personal holidays
Paid parental leave
Paid caregiver leave
Short-term disability
Long-term disability
Life insurance
Remote work
Dedicated home workspace requirements to protect member PHI/HIPAA information