Become a part of our caring community and help us put health first
 

Humana is seeking a Senior Quality Audit/Improvement Professional who will audit and monitor quality improvement programs for Humana’s Indiana Pathways and LTSS program. The Senior Quality Audit/Improvement Professional work assignments involve moderately complex to complex issues where the analysis of situations or data requires an in-depth evaluation of variable factors.

Position Responsibilities:

• Monitors quality investigations and compliance processes.
• Manages quality management system, department SharePoint/Teams, Quickbase, and department reporting.
• Analyzes and summarizes audit data for reporting to manager and makes recommendations on remediation.
• Collaborates with other business areas to identify root cause of non-compliance and lead corrective action activity.
• Audits charts and processes as needed for compliance.
• Audits records for quality of care and compliance with regulatory requirements.
• Completes and submits reports to CMS and state regulators as required for clinical studies.
• 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.

Use your skills to make an impact
 

Required Qualifications

• Five (5)+ years or work experience in a health insurance or health care setting.
• Experience with healthcare quality measures, i.e. HEDIS/STARS/CMS/Operational Quality.
• Experience and proficiency in tool development and management of SharePoint/Teams, Quickbase, etc.
• 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
• Previous quality or process improvement experience in a hospital or physician office practice
• Strong business skills, including sales and marketing objectives

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 HireVue to enhance our hiring and decision-making ability. HireVue 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.

Scheduled Weekly Hours

40

Pay Range

The compensation range below reflects a good faith estim