Quality Compliance Professional

Profile

Job Information
Humana
Quality Compliance Professional
in
Springfield
Ohio
Description
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.
Responsibilities
The Quality Compliance Professional 2 completes medical records reviews for Coordination of Care studies. Analyzes data and implement corrective actions as needed. Reviews medical records for supplemental data and enter data in supplemental data base. Understands department, segment, and organizational strategy and operating objectives, including their linkages to related areas. Makes decisions regarding own work methods, occasionally in ambiguous situations, and requires minimal direction and receives guidance where needed. Follows established guidelines/procedures.
Required Qualifications
Bachelor's degree or 5 years related Quality Improvement work
Ohio Licensed Practical Nurse (LPN) or Registered Nurse (RN) license; active with no restrictions
Knowledge of HEDIS/STARS/CMS/Quality
Clinical Managed Care background
Comprehensive knowledge of Microsoft Office Suite (i.e., excel, word, etc.)
Additional Requirements / Adherence
Workstyle: Remote Work at Home
Location:
Ohio
Schedule/Hours:
Monday through Friday 40-hour work week schedule 7:00 AM-6:00 PM Eastern
Anticipate occasional over-time or weekends as business needs require
Travel: 10%
Project and of collection medical records
Work at Home Requirements
Must have a separate room with a locked door that can be used as a home office to ensure you absolute and continuous privacy while you work
Must have accessibility to hardwired high speed internet with minimum speeds of 25Mx10M for a home office (Wireless and Satellite are prohibited)
Humana Driver's License, Insurance, Transportation Requirement
This role is part of Humana's Driver safety program and therefore requires an individual to have
a valid state driver's license,
reliable transportation,
and proof of personal vehicle liability insurance with at least 100/300/100 limits
Preferred Qualifications
Previous quality improvement or process improvement experience
Detail orientated and comfortable working with tight deadlines in a fast-paced environment
Ability to work independently under general instructions, self-directed and motivated
Strong oral/written communication and presentation skills
Strong analytical skills, able to manipulate and interpret data
Organizational and prioritization skills
Additional Information
Interview Format
As part of our hiring process for this opportunity, we will be using an exciting screening and interviewing technology called Modern Hire to enhance our hiring and decision-making ability. We use this technology to gain valuable information from you pertaining to your relevant skills and experience at a time that is best for your schedule.
You will be able to respond to the recruiters preferred response method via text, video or voice technologies. If you are selected for a screen, you may receive an email correspondence (please be sure to check your spam or junk folders often to ensure communication isn't missed) inviting you to participate. You should anticipate this screen to take about 15 to 30 minutes. Your recorded screen will be reviewed and you will subsequently be informed if you will be moving forward to next round of interviews.
Covid Compliance Policy
For this job, associates are required to be fully COVID vaccinated, including booster or undergo weekly COVID testing and wear a face covering while at work. The weekly testing will need to be done through an approved Humana vendor, and unvaccinated associates should follow all social distancing and masking protocols if they are required to come into a Humana facility or work outside of their home. We are a healthcare company committed to putting health and safety first for our members, patients, associates, and the communities we serve.
If progressed to offer, you will be required to:
Provide proof of full vaccination, including booster or commit to testing protocols
OR  
Provide proof of applicable exemption including any required supporting documentation
Medical, religious, state and remote-only work exemptions are available.
Scheduled Weekly Hours
40
Humana complies with all applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, sex, sexual orientation, gender identity or religion. We also provide free language interpreter services. See our ****

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