We ask that you have an active Registered Nurse license and residency in Louisiana. You will also have familiarity with the MCIP program through the Louisiana Department of Health and an understanding of Louisiana Medicaid quality expectations.

• 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 that you implement 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.

Required Qualifications

• 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.
• 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.

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

$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.