at Humana in Dover, Delaware, United States
Become a part of our caring community and help us put health first Humana is seeking 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.
Position Responsibilities: + Audits charts and processes as needed for compliance.
+ Audit records for quality of care and compliance with regulatory requirements.
+ Completes and submits reports to CMS and state regulators as required for clinical studies.
+ Analyzes and summarizes audit data for reporting to manager.
+ Understands department, segment, and organizational strategy and operating objectives, including their linkages to related areas.
+ Completes other assignments and participates in other projects as business areas' needs arise.
+ Participates in interdepartmental projects and activities.
The person in this role will have the following skillset:
+ Detail oriented and comfortable working with tight deadlines in a fast-paced environment.
+ Self-starter.
+ Critical thinking skills.
+ Good time management skills and the ability to work independently.
Use your skills to make an impact Required Qualifications + 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.
+ Proficient in Microsoft Office Word, Excel and PowerPoint
Preferred Qualifications + Bachelor's degree.
+ Audit experience in a healthcare setting.
+ Knowledge of Humana's internal policies, procedures 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.
Additional Information + Workstyle: Home. Home workstyle is defined as remote but will use Humana office space on an as needed basis for collaboration and other face-to-face needs.
+ Typical Work days/hours : Monday – Friday, 8:00 am – 5:00 pm Eastern Standard Time ( EST )
+ Travel: minimal travel to Indiana may be required.
Nationwide Remote – This is a remote nationwide position.
WAH Internet Requirements To ensure Home or Hybrid Home/Office employees' ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office employees must meet the following criteria:
+ At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is recommended; wireless, wired cable or DSL connection is suggested.
+ Satellite, cellular and microwave connection can be used only if approved by leadership.
+ Employees who live and work from Home in the state of California, Illinois, Montana, or South Dakota will be provided a bi-weekly payment for their internet expense.
+ Humana will provide Home or Hybrid Home/Office employees with telephone equipment appropriate to meet the business requirements for their position/job.
+ Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information.
Benefits Humana offers a variety of benefits to promote the best health and well-being of our employees and their families. We design competitive and flexible packages to give our employees a sense of financial security-both today and in the future, including:
+ Health benefits effective day 1
+ Paid time off, holidays, volunteer time and jury duty pay
+ Recognition pay
+ 401(k) retirement savings plan with employer match
+ Tuition assistance
+ Scholarships for eligible dependents
+ Parental and caregiver leave
+ Employee charity matching program
+ Network Resource Groups (NRGs)
+ Career development opportunities
HireVue As part of our hiring process for this opportunity, we will be using an interviewing technology called Modern Hire to enhance our hiring and decision-making ability. Modern Hire allows us to quickly connect and gain valuable information from you pertaining to your relevant skills and experience at a time that is best for your schedule.
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Scheduled Weekly Hours 40
Pay Range The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay decisions will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc.$63,400 – $87,400 per yearThis job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance.
Description of Benefits Humana, Inc. and its affiliated subsidiaries (collectively, 'Humana') offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and 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 and many other opportunities.
About us Humana Inc. ( NYSE : HUM ) is committed to putting health first – for our teammates, our customers and our company. Through our Humana insurance services and CenterWell healthcare services, we make it easier for the millions of people we serve to achieve their best health – delivering the care and service they need, when they need it. These efforts are leading to a better quality of life for people with Medicare, Medicaid, families, individuals, military service personnel, and communities at large.
Equal Opportunity Employer It is the policy of ?Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or because he or she is a protected veteran. It is also the policy of ?Humana?to take affirmative action to employ and to advance in employment, all persons regardless of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment.
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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