RN, Quality Assurance Professional

Humana

5d • $65,000 - $88,600 • Remote

About The Position

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 and play a critical role in identifying opportunities for improvement, strengthening processes, and supporting Humana's commitment to high-quality care, accountability, and continuous improvement. The ideal candidate brings a strong clinical background and a passion for improving healthcare quality and outcomes through objective analysis and problem-solving. 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.

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.
• Proficient 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.

Nice To Haves

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

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.
• Reviews 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.

Benefits

• medical
• dental
• 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

What This Job Offers

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