Quality Compliance Professional

About the role

The Quality Compliance Professional 2 completes annual quality reviews and research. Work assignments are varied and frequently require interpretation and independent determination of the appropriate courses of action. This is an Intern Position specifically targeting transitioning military service members and current military-approved spouses.

Responsibilities

• Complete medical records reviews for Coordination of Care studies
• Analyze data and implement corrective actions
• Review medical records for supplemental data and enter data in supplemental database
• Understand department, segment, and organizational strategy and operating goals, including their linkages to related areas
• Follow established guidelines and procedures

Required Qualifications

• Must be a Current Military Spouse approved for a spousal internship or a Transitioning Military Service Member under the DOD SkillBridge Internship Program
• Experience with HEDIS medical record review and abstraction
• Knowledge of HEDIS, Stars, CMS Quality programs, and healthcare quality measures
• Previous quality improvement, compliance, or managed care experience

Preferred Qualifications

• Bachelor's Degree or Equivalent Experience
• Active, unrestricted Registered Nurse (RN) or Licensed Practical Nurse (LPN) license in good standing
• Experience reviewing, interpreting, and abstracting information from medical records
• Clinical experience in a health plan, physician practice, hospital, or other healthcare setting

Work Environment

• Remote position with occasional travel to Humana's offices for training or meetings
• Self-provided internet service must meet: minimum download speed of 25 Mbps and upload speed of 10 Mbps; wireless, wired cable or DSL connection suggested
• Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information
• Humana reserves the right to require associates to upgrade their internet service if necessary

Internship Program Details

• The DOW SkillBridge Internship Program provides transitioning military service members time to gain civilian work experience while still on active duty
• The Military Spouse Fellowship Program connects military spouses with employers offering a variety of professional onsite, field, or remote based opportunities for a period up to 12 weeks
• Networking opportunities are provided while you participate in the Internship or Fellowship
• Due to factors such as location or requirements that cannot be modified, full-time employment upon completion is not guaranteed