Senior Quality Compliance Professional

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.

About the role

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 to support quality initiatives, audit readiness, corrective action management, regulatory reporting, and performance improvement activities.

Responsibilities

• 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 implementation of 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.

Requirements

• 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.
• Ability to analyze data, identify trends, summarize findings, and recommend appropriate actions.
• Demonstrated ability to work independently, manage multiple priorities, meet deadlines, and collaborate across teams.
• Proficiency with Microsoft Office.

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 at Home Requirements

• 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.
• Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information.

While this is a remote position, occasional travel to Humana's offices for training or meetings may be required.

Schedule

Scheduled Weekly Hours: 40

Pay

The pay range reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, and certifications.

$78,400 - $107,800 per year

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

Benefits

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