Quality Compliance Professional
About the role
The Quality Compliance Professional 2 completes annual quality reviews and research. The Quality Compliance Professional 2 work assignments are varied and frequently require interpretation and independent determination of the appropriate courses of action. The Quality Compliance Professional 2 completes medical records reviews for Coordination of Care studies. Analyze data and implement corrective actions as needed. Review medical records for supplemental data and enter data in supplemental database.
Responsibilities
- Analyze data and implement corrective actions as needed
- Review medical records for supplemental data and enter data in supplemental database
- Understand department, segment, and organizational strategy and operating objectives, including their linkages to related areas
- Follow established guidelines/procedures
Requirements
- Must reside in Oklahoma
- Bachelor's degree
- Registered Nurse (RN) license
- 2+ years clinical background
- Prior experience in quality compliance in a healthcare setting
- Strong oral / written communication
- Comprehensive knowledge of Microsoft Office
Preferred Qualifications
- Knowledge of HEDIS/Stars/CMS/Quality
- Previous quality or process improvement experience in healthcare
- Detail orientated and comfortable working with tight deadlines
Skills
Understand department, segment, and organizational strategy and operating objectives, including their linkages to related areas. Follow established guidelines/procedures. Analyze data and implement corrective actions as needed. Review medical records for supplemental data and enter data in supplemental database. Strong oral / written communication. Comprehensive knowledge of Microsoft Office. Detail orientated and comfortable working with tight deadlines.
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.
Pay
$71,100 - $97,800 per year
Schedule
This is a remote position, but occasional travel to Humana's offices for training or meetings may be required.
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 Humana: Humana Inc. (NYSE: HUM) is a leading U.S. healthcare 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 and Medicaid, families, individuals, military service personnel, and communities at large. Learn more about what we offer at Humana.com and at CenterWell.com.
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.