Humana is looking for a Senior Quality Audit/Improvement Professional who will audit and monitor quality improvement programs for compliance with Indiana Medicaid and Duals plans. The 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:
- Support oversight of compliance issues related to clinical programs for the Indiana plans at Humana.
- Represent the Market Compliance team by taking the lead for internal and external audits related to Indiana clinical programs.
- Present to leadership and state auditors on compliance related items.
- Monitor quality investigations and compliance processes for the Indiana plans.
- Manage quality management system, department SharePoint/Teams, Quickbase, and department reporting.
- Collaborate with other departments to identify cause of non-compliance and lead corrective action activity.
- Audits records for quality of care and compliance with regulatory requirements.
- Complete and submit reports to CMS and state regulators for clinical studies.
- Understand department, segment, and organizational strategy and operating goals, including their linkages to related areas.
- Complete other assignments and participate in other projects for the Market Compliance team as departments' needs arise.
- Participate in process improvement projects for the Indiana programs.
- Atten onsite meetings in Indianapolis with the Indiana Market team and state regulators,.
Use your skills to make an impact
Required Qualifications
- Five+ years of experience in a health insurance or health care setting.
- Experience with the development of processes related to Critical Incidents tailored to meet specific state needs
- Experience in tool development and management of SharePoint/Teams, Quickbase
Preferred Qualifications
- Bachelor's degree
- Audit experience in a healthcare setting
- Knowledge of Humana's internal policies and systems
- Experience with Long-term Care programs
- Previous quality or process improvement experience
- Business skills, including sales and marketing goals
Work at Home 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 required; wireless, wired cable or DSL connection is suggested. In certain roles, the minimum recommended internet speed required by Humana may not be sufficient for business needs. Humana reserves the right to require associates to upgrade their internet service if necessary. 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 Hours
40
Pay Range
The 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.
$78,400 - $107,800 per year
This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance.
Description of Benefits
Humana, 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, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.
