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.
The Quality Compliance Professional 2 completes medical records reviews for Coordination of Care studies. Analyze data and implement corrective actions as needed. Review medical records for supplemental data and enter data in supplemental data base. Understand department, segment, and organizational strategy and operating objectives, including their linkages to related areas. Follows established guidelines/procedures.
REQUIRED QUALIFICATIONS- Must reside in Oklahoma
- Bachelor's degree
- Registered Nurse (RN) license
- 2+ years clinical background
- Prior experience in quality compliance in a healthcare setting
- Strong oral / written communication
- Comprehensive knowledge of Microsoft Office
PREFERRED QUALIFICATIONS- Knowledge of HEDIS/Stars/CMS/Quality
- Previous quality or process improvement experience in healthcare
- Detail orientated and comfortable working with tight deadlines
Additional InformationWork at Home CriteriaTo 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.
Travel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be required.
Scheduled Weekly Hours40
Pay RangeThe 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 year
This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance.
Description of BenefitsHumana, 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, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.
