Quality Compliance Professional

Become a part of our caring community 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. 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 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. Description This is an Intern Position, specifically targeting transitioning military service member, 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. Use your skills to make an impact Required 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. Preferred Qualifications 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. 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 1 About us About Humana: Humana Inc. (NYSE: HUM) is a leading U.S. healthcare company. Through our Humana insurance services and our CenterWell healthcare services, we make it easier for the millions of people we serve to achieve their best health – delivering the care and service they need, when they need it. These efforts are leading to a better quality of life for people with Medicare and Medicaid, families, individuals, military service personnel, and communities at large. Learn more about what we offer at Humana.com and at CenterWell.com. ​ Equal Opportunity Employer It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status. It is also the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and VEVRAA, to employ and to advance in employment individuals with disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment.