[Hiring] Quality Compliance Professional @Humana

Role 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.

• Completes medical records reviews for Coordination of Care studies.
• Analyzes data and implements corrective actions.
• Reviews medical records for supplemental data and enters data in supplemental database.
• Understands department, segment, and organizational strategy and operating goals, including their linkages to related areas.
• Occasionally seeks guidance regarding own work methods and follows established guidelines/procedures.

Are you a transitioning military service member or a military spouse looking for an internship that supports the goal to put health first? The DOW SkillBridge Internship and Military Spouse Fellowship Programs will provide you with main training to perform your internship. You will partner with your team to support members, projects, and to meet goals affecting outcomes. The professionals you work with at Humana will depend on the type of internship you select. They may include healthcare professionals, HR, and IT, to name a few. The objective is to support and facilitate care for members.

This is an Intern Position, specifically targeting transitioning military service members and current military approved spouses. The DOW SkillBridge Internship Program provides transitioning military service members time to gain civilian work experience while still on active duty.

The Military Spouse Fellowship Program connects military spouses with employers offering a variety of professional onsite, field, or remote based opportunities for a period up to 12 weeks.

We will provide networking opportunities while you participate in the Internship or Fellowship. Due to factors such as location, or requirements that cannot modify, we do not guarantee full-time employment upon completion of the Internship or Fellowship.

Qualifications

• 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.

Requirements

• Bachelor's Degree or Equivalent Experience (Preferred).
• Active, unrestricted Registered Nurse (RN) or Licensed Practical Nurse (LPN) license in good standing (Preferred).
• Experience reviewing, interpreting, and abstracting information from medical records (Preferred).
• Clinical experience in a health plan, physician practice, hospital, or other healthcare setting (Preferred).
• Work at Home Requirements: Minimum download speed of 25 Mbps and upload speed of 10 Mbps required; wireless, wired cable or DSL connection suggested.
• Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information.
• Travel: Occasional travel to Humana's offices for training or meetings may be required.

Benefits

• Networking opportunities during the Internship or Fellowship.