Quality Compliance Professional

Summary

Humana is a healthcare company providing insurance and healthcare services. The Quality Compliance Professional 2 completes medical record reviews and research for quality programs, analyzes data, enters supplemental data, and implements corrective actions.

Responsibilities

• The Quality Compliance Professional 2 completes annual quality reviews and research
• The Quality Compliance Professional 2 completes medical records reviews for Coordination of Care studies
• Analyze data and implement corrective actions
• Review medical records for supplemental data and enter data in supplemental data base
• Understand department, segment, and organizational strategy and operating goals, including their linkages to related areas
• Regarding own work methods, occasionally in, and and receive guidance where needed
• Follow established guidelines/procedures

Skills

• Must be a Current Military Spouse approved for a spousal internship or a Transitioning Military Service Member under the DOD SkillBridge Internship Program
• Experience with HEDIS medical record review and abstraction
• Knowledge of HEDIS, Stars, CMS Quality programs, and healthcare quality measures
• Previous quality improvement, compliance, or managed care experience
• Bachelor's Degree or Equivalent Experience
• Active, unrestricted Registered Nurse (RN) or Licensed Practical Nurse (LPN) license in good standing
• Experience reviewing, interpreting, and abstracting information from medical records
• Clinical experience in a health plan, physician practice, hospital, or other healthcare setting

Qualifications

Must Haves

• Must be a Current Military Spouse approved for a spousal internship or a Transitioning Military Service Member under the DOD SkillBridge Internship Program
• Experience with HEDIS medical record review and abstraction
• Knowledge of HEDIS, Stars, CMS Quality programs, and healthcare quality measures
• Previous quality improvement, compliance, or managed care experience

Nice to Haves

• Bachelor's Degree or Equivalent Experience
• Active, unrestricted Registered Nurse (RN) or Licensed Practical Nurse (LPN) license in good standing
• Experience reviewing, interpreting, and abstracting information from medical records
• Clinical experience in a health plan, physician practice, hospital, or other healthcare setting

Benefits

• Internship or fellowship opportunities for transitioning military service members and current military-approved spouses
• Main training to perform the internship through the DOW SkillBridge Internship and Military Spouse Fellowship Programs
• Networking opportunities during the Internship or Fellowship
• Remote work opportunity
• Occasional travel to Humana offices for training or meetings may be required