RN, Quality Assurance Professional

About the Role

The RN, Quality Assurance Professional 2 serves as a clinical subject matter expert within Internal Audit, supporting audits across CenterWell, Care Management, Utilization Management, and other healthcare operations. You will work closely with audit professionals and business leaders, playing a critical role in identifying opportunities for improvement, strengthening processes, and supporting Humana's commitment to high-quality care, accountability, and continuous improvement. This unique role offers an opportunity to apply nursing expertise beyond direct patient care by influencing enterprise-wide improvements in clinical operations, regulatory compliance, and risk management.

Responsibilities

• Serve as the clinical subject matter expert supporting Internal Audit engagements across CenterWell, Care Management, Utilization Management, and other healthcare delivery functions.
• Partner with audit professionals to provide clinical insight during audit planning, testing, and reporting activities, helping evaluate the effectiveness of key processes, controls, and compliance with regulatory, contractual, and organizational requirements.
• Review clinical documentation, operational workflows, and quality management activities to identify potential risks, evaluate the effectiveness of controls, and recommend process improvements that enhance compliance, quality, and operational performance.

Requirements

• An active, unrestricted RN license.
• Minimum of 3 years of clinical nursing experience, with demonstrated knowledge of care management, utilization management, population health, or healthcare operations.
• Experience reviewing clinical documentation, healthcare processes, and operational workflows to assess compliance, quality, and effectiveness.
• Knowledge of healthcare regulations, accreditation standards, and industry best practices, including CMS, NCQA, URAC, or state and federal requirements.
• Proficiency in Microsoft Office Suite, including Word, Excel, and PowerPoint, with the ability to support operational and audit activities.
• Strong written and oral communication skills, with the ability to prepare clear, concise reports and collaborate effectively with stakeholders at all levels of the organization.

Preferred Qualifications

• Certification in Healthcare Quality (CPHQ), Case Management (CCM), Utilization Management (CPUM), Internal Auditing (CIA), or related discipline.
• Experience in managed care or healthcare administration.
• Experience participating in audits, assessments, quality reviews, or compliance monitoring activities within care management, utilization management, or healthcare operations.

Additional Information

Workstyle: This is a remote position with up to 5% travel required for team engagement meetings, which may occur outside your state of residence. Typical Workdays and Hours: Monday – Friday, 8:00 AM – 5:00 PM Eastern Time (ET). Work at Home Requirements: Self-provided internet service must meet minimum download speed of 25 Mbps and upload speed of 10 Mbps; a dedicated workspace is required to protect member PHI / HIPAA information.

Pay

The compensation range for this full-time position is $65,000 - $88,600 per year, with eligibility for a bonus incentive plan based on company and/or individual performance.

Benefits

Humana offers competitive benefits, including medical, dental, and vision insurance, a 401(k) retirement savings plan, paid time off, holidays, parental and caregiver leave, disability and life insurance, and more.

About Humana

Humana Inc. (NYSE: HUM) is a leading U.S. healthcare company, providing insurance and healthcare services to millions through Humana insurance and CenterWell healthcare services. We aim to improve the quality of life for those with Medicare and Medicaid, families, individuals, military personnel, and communities at large. Learn more at Humana.com and CenterWell.com.