Quality Compliance Professional
The Quality Compliance Professional role is an integral part of the Michigan Quality Department. You will collaborate with internal and external customers to meet benchmarks, goals and complete time sensitive deliverables for quality clinical and non-clinical projects. You will operate as a subject matter expert in Quality Compliance.
The Quality Compliance Professional 2 work assignments are varied and frequently require interpretation and independent determination of the appropriate courses of action.
Responsibilities
- Complete medical records reviews
- Support adherence to regulatory requirements for member and health plan management
- Guide and support efforts for successful NCQA accreditation
- Analyze data and implement corrective actions as needed
- Understand department, segment, and organizational strategy and operating objectives, including their linkages to related areas
- Make decisions regarding work methods, occasionally in ambiguous situations, requiring minimal direction and receiving guidance where needed
- Follow established guidelines/procedures
- Additional responsibilities based on business need
Required Qualifications
- Must reside in the state of Michigan
- Bachelor's degree
- Clinical background
- Experience with Long-term service and support (LTSS) populations
- Experience with National Committee for Quality Assurance (NCQA) Accreditation
- Strong oral / written communication and presentation skills
- Strong analytical skills, able to manipulate and interpret data
- Office practice / hospital experience
- Comprehensive knowledge of Microsoft Office Word, Excel and PowerPoint
Preferred Qualifications
- Registered Nurse (RN) license
- 2+ years of experience with Long-term service and support (LTSS) populations
- 2+ years of experience with National Committee for Quality Assurance (NCQA) Accreditation
- Knowledge of HEDIS/Stars/CMS/Quality
- Experience with Dual Eligible Special Needs (DSNP) programs
- Certified Professional in Healthcare Quality (CPHQ)
- Project Management skills
- Detail orientated and comfortable working with tight deadlines in a fast-paced environment
- Ability to work independently under general instructions, self-directed and motivated
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.
Schedule
Scheduled Weekly Hours: 40
Pay
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. $71,100 - $97,800 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 (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, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.