Quality Compliance Professional

Humana • Oklahoma City, OK

5d • Remote

About The Position

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 data base. Understand department, segment, and organizational strategy and operating objectives, including their linkages to related areas. Follows established guidelines/procedures. Use your skills to make an impact.

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

Nice To Haves

• Knowledge of HEDIS/Stars/CMS/Quality
• Previous quality or process improvement experience in healthcare
• Detail orientated and comfortable working with tight deadlines

Responsibilities

• Completes annual quality reviews and research.
• Completes medical records reviews for Coordination of Care studies.
• Analyzes data and implements corrective actions as needed.
• Reviews medical records for supplemental data and enters data in supplemental data base.
• Understands department, segment, and organizational strategy and operating objectives, including their linkages to related areas.
• Follows established guidelines/procedures.

Benefits

• medical
• dental
• 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

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level