Quality Improvement Professional

Humana • Work at Home - Indiana, IN

2d • $65,000 - $88,600 • Remote

About The Position

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. The Quality Improvement Professional's work assignments are varied and frequently require interpretation and independent determination of the appropriate courses of action.

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

Nice To Haves

• 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.

Responsibilities

• Audits charts and processes for compliance.
• Audit records for quality of care and compliance with regulatory requirements.
• Complete and submit reports to CMS and state regulators for clinical studies.
• Analyze audit data for reporting to manager.
• Understand department, segment, and organizational strategy and operating goals, including their linkages to related areas.
• Complete other assignments and participate in other projects as departments' needs arise.
• Participate in interdepartmental activities.
• Use your skills to make an impact

Benefits

• 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
• many other opportunities

What This Job Offers

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