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

The Quality Assurance, Clinical Professional 2 develops and implements programs to establish and maintain quality standards of existing products and services, as well as developing programs to focus associates on the quality of care provided to members. The Quality Assurance, Clinical Professional 2 work assignments are varied and frequently require interpretation and independent determination of the appropriate courses of action.

The Quality Assurance, Clinical Professional 2 conducts quality audits to improve the quality of care management services, the member experience and clinical outcomes. Collaborates with other auditors, operations and business partners on quality, process and performance improvement. Understands department, segment, and organizational strategy and operating objectives, including their linkages to related areas. Makes decisions regarding own work methods, occasionally in ambiguous situations, and requires minimal direction, but receives guidance when needed. Follows established guidelines/procedures. Trains and/or coaches staff and management in areas such as quality improvement, process management and reliability science. Maintains communications with operations and business partners regarding quality assurance activities.

Breakdown of responsibilities:

· Listen to assigned calls.

· Review documentation captured as a result of the call.

· Conduct quality audits using the specified quality audit tool.

· Assist with focused audits as requested.

· Work on special projects to improve the member experience and clinical outcomes.

· Participate in calibration sessions to improve auditing consistency.

· Assist with education/huddles to help frontline associates improve the quality of their work.

· Interact with operations and other partners as needed to provide feedback and coordinate quality improvement initiatives.

· Other duties as assigned to support the improvement and advancement of the quality organization.

Use your skills to make an impact
 

Required Qualifications

· RN or Social worker license

· 4 or more years of clinical experience

· Excellent organizational skills required

· Detail-oriented

· Demonstrated ability to articulate ideas effectively in both written and oral forms

· Excellent PC skills (including MS Word & Excel)

Preferred Qualifications

· Experience with Humana systems such as: CGX, HCAT, Verint, or Genesys.

  Previous quality auditing experience

· Experience in managed care or health care administration desired.

· Experience reviewing clinical records, calls, and the documentation to evaluate the quality of the service provided.

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.
• 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 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.

 

$65,000 - $88,600 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, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.

About us
 

Humana Inc. (NYSE: HUM) is committed to putting health first – for our teammates, our customers and our company. Through our Humana insurance services and 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, Medicaid, families, individuals, military service personnel, and communities at large.

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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.