Remote Quality Compliance Specialist – NCQA & Data

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

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.