Quality Compliance Professional

Humana Inc; Northern (KY); Hybrid; USD 71,000 - 98,000; Full time

Benefits offered by this job

Medical, dental and vision benefits

401(k) retirement savings plan

Paid time off

Bonus incentive plan

Job summary

Humana Inc. is seeking a Quality Compliance Professional to join the Michigan Quality Department as a remote, full-time specialist. You will review medical records, support regulatory adherence for member and health plan management, and guide NCQA accreditation efforts, using data analysis to drive corrective actions.

Ideal candidates have a clinical background, NCQA experience, strong communication, and proficiency with Microsoft Office. Travel to Humana offices may be required occasionally.

Qualifications

• Must reside in Michigan
• Bachelor's degree required
• Clinical background mandatory
• Experience with LTSS populations
• Experience with NCQA Accreditation
• Strong oral/written communication and presentation skills
• Strong analytical skills with data manipulation/interpretation
• Office practice / hospital experience
• Proficiency in Microsoft Office Suite (Word, Excel, PowerPoint)

Responsibilities

• Complete medical records reviews and support regulatory requirements for member and health plan management
• Guide and support NCQA accreditation efforts
• Analyze data and implement corrective actions as needed
• Collaborate with internal and external stakeholders to meet benchmarks and deadlines

Skills

Clinical background

Analytical skills

Communication skills

Office experience

Education

Bachelor's degree

Tools

Microsoft Office (Word/Excel/PowerPoint)

Job description

## Quality Compliance ProfessionalApply: Remote Michigan: Full time: Posted Today: R-429472# **Become a part of our caring community**The Quality Compliance Professional role is an integral part of the Michigan Quality Department. You will collaborate with internal and external customers to meet benchmarks, goals and complete time sensitive deliverables for quality clinical and non-clinical projects. You will operate as a subject matter expert in Quality Compliance. 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, supports adherence to regulatory requirements for member and health plan management. Guide and support efforts for successful NCQA accreditation. Analyze data and implement corrective actions as needed. Understand department, segment, and organizational strategy and operating objectives, including their linkages to related areas. Makes decisions regarding work methods, occasionally in ambiguous situations, and requires minimal direction and receive guidance where needed. Follow established guidelines/procedures. Additional responsibilities based on business need.# **Use your skills to make an impact**Required Qualifications* Must reside in the state of Michigan* Bachelor's degree* Clinical background* Experience with Long-term service and support (LTSS) populations* Experience with National Committee for Quality Assurance (NCQA) Accreditation* Strong oral / written communication and presentation skills* Strong analytical skills, able to manipulate and interpret data* Office practice / hospital experience* Comprehensive knowledge of Microsoft Office Word, Excel and PowerPointPreferred Qualifications* Registered Nurse (RN) license* 2+ years of experience with Long-term service and support (LTSS) populations* 2+ years of experience with National Committee for Quality Assurance (NCQA) Accreditation* Knowledge of HEDIS/Stars/CMS/Quality* Experience with Dual Eligible Special Needs (DSNP) programs* Certified Professional in Healthcare Quality (CPHQ)* Project Management skills* Detail orientated and comfortable working with tight deadlines in a fast-paced environment* Ability to work independently under general instructions, self-directed and motivatedWork at Home 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 required; wireless, wired cable or DSL connection is suggested. In certain roles, the minimum recommended internet speed required by Humana may not be sufficient for business needs. Humana reserves the right to require associates to upgrade their internet service if necessary. Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information.Travel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be required.**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 will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc.$71,100 - $97,800 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, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.# **About us**About Humana: Humana Inc. (NYSE: HUM) is a leading U.S. healthcare company. Through our Humana insurance services and our 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 and Medicaid, families, individuals, military service personnel, and communities at large. Learn more about what we offer at Humana.com and at CenterWell.com.