Home Health Quality Assurance Manager at Humana

Toledo, Ohio, United States -

Full Time

Start Date

Immediate

Expiry Date

14 Feb, 26

Salary

143000.0

Posted On

16 Nov, 25

Experience

5 year(s) or above

Remote Job

Yes

Telecommute

Yes

Sponsor Visa

Skills

Quality Assurance, Performance Improvement, Regulatory Compliance, Data Analysis, Continuous Quality Improvement, Clinical Excellence, Patient Safety, Accreditation Management, Training, Collaboration, Policy Development, Audit Frameworks, Communication, Leadership, Healthcare Quality, Process Redesign

Industry

Insurance

Description

Become a part of our caring community and help us put health first The Home Health Quality Assurance Manager is responsible for leading the development, implementation, and oversight of the Quality Assurance and Performance Improvement (QAPI) Program to ensure the delivery of high-quality, compliant home health services. This role sets the quality strategy, designs audit frameworks, monitors performance metrics, and drives continuous improvement initiatives in alignment with regulatory and accreditation standards, including CMS and Medicare Advantage requirements. The manager also prepares the organization for accreditation and ensures sustained compliance. Use your skills to make an impact Key Responsibilities Program Leadership: Develop, implement, and maintain a comprehensive QAPI program focused on clinical excellence, patient safety, and regulatory compliance. Regulatory Compliance: Ensure adherence to all applicable regulations, accreditation standards, and payer requirements for home health services. Quality Audits: Design and oversee audits of clinical documentation, care delivery, and patient outcomes; analyze findings to identify trends and improvement opportunities. Data-Driven Improvement: Utilize data analysis, gap assessments, and root cause analysis to inform corrective actions and process enhancements. Collaboration: Partner with interdisciplinary teams to implement clinical and operational improvements that enhance patient care and efficiency. Reporting: Present audit results, performance trends, and improvement outcomes to senior leadership and quality committees. Policy Development: Create and maintain quality policies, procedures, and tools, including audit instruments and inter-rater reliability methodologies. Performance Monitoring: Establish key quality indicators, set benchmarks, and track progress toward goals. Accreditation Management: Lead efforts to obtain and maintain home health-specific accreditations and certifications. Training & Education: Support staff training on clinical operations, regulatory standards, and quality programs. Travel: Up to 15% travel for onsite assessments, education, and support. Qualifications Active clinical license (RN, PT, OT, or equivalent) required. Bachelor’s degree in healthcare or related field required; Master’s preferred. CPHQ certification preferred; Lean Six Sigma a plus. Strong knowledge of CMS Conditions of Participation and Medicare Advantage regulations. Minimum 5 years of healthcare quality experience, including 2 years in a leadership role. Proven ability to lead accreditation efforts in a home health setting preferred. Expertise in continuous quality improvement methodologies, data analysis, and process redesign. Excellent communication and presentation skills for senior leadership engagement. 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. $104,000 - $143,000 per year This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance. Description of Benefits Humana, Inc. and its affiliated subsidiaries (collectively, “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, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities. About Us About OneHome: OneHome coordinates a full range of post-acute care ranging from home health, infusion therapy and durable medical equipment services at patients’ homes. OneHome’s patient focused model creates one integrated point of accountability that coordinates with physicians, hospitals and health plans serving more than one million health plan members nationwide. OneHome was acquired by Humana in 2021 to advance value-based care. Our culture is inclusive, diverse, and above all, caring. It is important to us that our employees are engaged, supported and fairly treated. We offer a comprehensive benefits package to ensure the health and financial well-being of you and your family. About Humana: Humana Inc. (NYSE: HUM) is committed to putting health first – for our teammates, our customers, and our company. Through our Humana insurance services, and our CenterWell healthcare services, we make it easier for the millions of people we serve to achieve their best health – delivering the care and service they need, when they need it. These efforts are leading to a better quality of life for people with Medicare, Medicaid, families, individuals, military service personnel, and communities at large. Equal Opportunity Employer It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status. It is also the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and VEVRAA, to employ and to advance in employment individuals with disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment.

Responsibilities

The Home Health Quality Assurance Manager leads the development and oversight of the Quality Assurance and Performance Improvement (QAPI) Program to ensure high-quality home health services. This role involves designing audit frameworks, monitoring performance metrics, and driving continuous improvement initiatives in compliance with regulatory standards.