[Hiring] Senior Accreditation & Licensing Professional @Humana

Role Description

The Senior Accreditation & Licensing Professional leads accreditation, licensing, regulatory compliance, audit readiness, and quality improvement initiatives to ensure compliance with accreditation standards, state and federal regulations, contractual requirements, and organizational policies. This role independently manages moderately complex to complex assignments, partners across the organization to identify and mitigate risks, drives continuous improvement efforts, and influences departmental strategy through data-driven recommendations.

The Senior Accreditation Professional accreditation emphasizes quality assurance and a commitment to continuous quality enhancement. Begins to influence department’s strategy. Makes decisions on moderately complex to complex issues regarding technical approach for project components, and work is performed without direction. Exercises considerable latitude in determining objectives and approaches to assignments.

Key Responsibilities

• Accreditation & Quality Assurance
  • Lead accreditation readiness activities and support external reviews, audits, and surveys.
  • Monitor compliance with accreditation standards, regulatory requirements, and organizational policies.
  • Analyze performance measures and quality outcomes to identify improvement opportunities.
  • Develop and implement corrective action plans to address compliance gaps.
  • Serve as a subject matter expert on accreditation standards and quality management practices.
• Licensing & Regulatory Operations
  • Partner with Corporate Licensing to obtain, maintain, and renew Third Party Administrator (TPA) licenses.
  • Coordinate licensing applications, renewals, and regulatory filings across applicable states.
  • Lead governance meetings to monitor licensing status, timelines, and compliance requirements.
  • Collaborate with Legal, Compliance, Risk Management, and operational teams to assess and pursue UM/UR licensure needs.
  • Monitor regulatory changes and maintain licensing documentation, compliance calendars, and tracking tools.
• Internal Audit & Compliance Readiness
  • Lead preparation for internal audits and other compliance reviews.
  • Coordinate audit documentation, responses, and stakeholder engagement.
  • Identify compliance risks, control gaps, and operational vulnerabilities.
  • Partner with business leaders to develop and implement corrective action plans.
  • Maintain ongoing audit readiness and track remediation activities.
• Strategic Leadership & Continuous Improvement
  • Partner with cross-functional teams to support accreditation, licensing, compliance, and audit readiness initiatives.
  • Analyze data and operational performance to identify risks, opportunities, and process improvements.
  • Develop reports, metrics, dashboards, and tracking tools to support compliance and business decision-making.
  • Lead process improvement and corrective action initiatives that enhance quality, efficiency, and regulatory compliance.
  • Communicate findings, recommendations, and project outcomes to leadership and stakeholders.
  • Support departmental strategy and organizational growth through continuous improvement and regulatory excellence.

Qualifications

• Bachelor's degree.
• Five (5) or more years of experience in accreditation, compliance, licensing, healthcare operations, quality management, risk management, analytics, process improvement, or program implementation.
• Three (3) or more years of experience in process improvement, data analytics, compliance, risk management, and/or program management.
• Strong analytical, problem-solving, and technical skills.
• Advanced proficiency in Excel, Access, and database management.
• Ability to translate data into actionable insights and solutions.
• Experience working with cross-functional teams and stakeholders.
• Exceptional written, verbal, organizational, and project management skills.
• Demonstrated ability to manage multiple priorities and drive results independently.
• Commitment to continuous improvement and enhancing consumer experiences.

Preferred Qualifications

• Advanced degree in Healthcare Administration, Public Health, Business Administration, Healthcare Analytics, Business Analytics, or a related field.
• Experience supporting NCQA, URAC, CMS, or other regulatory/accreditation programs.
• Experience managing state licensing activities, including TPA, UM, or UR licenses.
• Knowledge of healthcare regulatory requirements, delegated services, and payer operations.
• Experience with SQL, data modeling, Tableau, Power BI, Qlik, or similar analytics tools.
• Experience leading audit readiness, compliance remediation, and process improvement initiatives.
• Strong research, investigative, and root-cause analysis skills.

Work at 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

The compensation range below 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, certifications, etc.

$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

• Humana, Inc. and its affiliated subsidiaries offer 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.
• 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.