Quality Improvement Professional

About the role

Become a part of our caring community. Humana is looking for a Quality Audit/Improvement Professional who will audit and monitor quality improvement programs for Humana's Indiana Pathways and LTSS program.

Responsibilities

• Audits charts and processes for compliance.
• Audits records for quality of care and compliance with regulatory requirements.
• Completes and submits reports to CMS and state regulators for clinical studies.
• Analyzes audit data for reporting to manager.
• Understand department, segment, and organizational strategy and operating goals, including their linkages to related areas.
• Completes other assignments and participates in other projects as departments' needs arise.
• Participates in interdepartmental activities.

Requirements

• Two (2) years of relevant experience in health insurance or health care OR two (2) years of relevant experience in auditing.
• Experience learning new software programs and systems.
• Bachelor's degree.
• Audit experience in a healthcare setting.
• Knowledge of Humana's internal policies and systems.
• Experience with Long-term Care programs.
• Registered Nurse, Licensed Practical Nurse (LPN), or Master's/Bachelor's in social work.
• Knowledge of HEDIS/Stars/CMS/Operational Quality.
• Previous quality or process improvement experience in a hospital or physician office practice.

Preferred Qualifications

• Bachelor's degree.
• Registered Nurse, Licensed Practical Nurse (LPN), or Master's/Bachelor's in social work.
• Knowledge of HEDIS/Stars/CMS/Operational Quality.
• Previous quality or process improvement experience in a hospital or physician office practice.

Additional Information

• Workstyle: Home.
• Typical Work days/hours: Monday – Friday, 8:00 am – 5:00 pm Eastern Standard Time (EST).
• Work at Home Requirements: Self-provided internet service of Home or Hybrid Home/Office employees must meet minimum download speed of 25 Mbps and upload speed of 10 Mbps.
• Travel: Occasional travel to Humana's offices for training or meetings may be required.
• Scheduled Weekly Hours: 40.

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, 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.

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.