Quality Compliance Professional

This is a fully remote position, open to applicants in Michigan.

📋 Description

• Collaborate with both internal and external stakeholders to achieve objectives and targets.

• Complete time-sensitive tasks for high-quality clinical and non-clinical projects.

• Serve as a subject matter expert in Quality Compliance.

• Conduct reviews of medical records.

• Ensure compliance with regulatory requirements for member and health plan management.

• Facilitate and support initiatives aimed at obtaining successful NCQA accreditation.

• Analyze data and initiate corrective actions as necessary.

• Comprehend departmental, segment, and organizational strategies and operational goals.

• Make informed decisions regarding work methods in situations that may be unclear.

• Adhere to established guidelines and procedures.

• Undertake additional responsibilities as required by business needs.

• Occasionally travel to Humana offices for training or meetings.

⛳️ Requirements

• Must be a resident of the state of Michigan.

• Bachelor's degree required.

• Clinical experience is essential.

• Familiarity with Long-term service and support (LTSS) populations is necessary.

• Experience with National Committee for Quality Assurance (NCQA) Accreditation is required.

• Excellent oral and written communication, as well as presentation skills.

• Strong analytical abilities, capable of manipulating and interpreting data.

• Experience in office practice or hospital settings.

• Proficient in Microsoft Office applications, including Word, Excel, and PowerPoint.

• Preferred: Registered Nurse (RN) license.

• Preferred: At least 2 years of experience working with Long-term service and support (LTSS) populations.

• Preferred: At least 2 years of experience related to National Committee for Quality Assurance (NCQA) Accreditation.

• Preferred: Understanding of HEDIS/Stars/CMS/Quality metrics.

• Preferred: Experience with Dual Eligible Special Needs (DSNP) programs.

• Preferred: Certification as a Professional in Healthcare Quality (CPHQ).

• Preferred: Skills in project management.

• Preferred: Detail-oriented with the ability to work under tight deadlines in a fast-paced environment.

• Preferred: Ability to work independently with minimal supervision, self-motivated, and driven.

• Home internet service should have a minimum download speed of 25 Mbps and upload speed of 10 Mbps.

• Work from a dedicated space free from ongoing interruptions to protect member PHI / HIPAA information.

• Occasional travel to Humana offices for training or meetings may be necessary.

🏝️ Benefits

• Bonus incentive plan based on company and/or individual performance.

• Medical benefits.

• Dental benefits.

• Vision benefits.

• 401(k) retirement savings plan.

• Paid time off.

• Company holidays.

• Personal holidays.

• Paid parental leave.

• Paid caregiver leave.

• Short-term disability coverage.

• Long-term disability coverage.

• Life insurance.

• Flexible work arrangement, including home or hybrid home/office options.

• Dedicated workspace and internet requirements to facilitate remote work.