Quality Compliance Professional

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

📋 Description

• Conduct annual quality assessments and research initiatives.

• Perform medical record evaluations for Coordination of Care studies.

• Analyze data and take corrective actions as needed.

• Review medical records to gather supplemental data.

• Input supplemental data into the designated database.

• Interpret findings and independently decide on the appropriate courses of action across various assignments.

• Comprehend departmental, segment, and organizational strategies as well as operational objectives.

• Adhere to established guidelines and procedures.

• Collaborate with the team to assist members and projects, aiming to achieve goals that impact outcomes.

• Facilitate and support care for members.

• Engage in networking opportunities through internships or fellowships.

• Occasionally travel to Humana offices for training sessions or meetings.

⛳️ Requirements

• Must be an active military spouse approved for a spousal internship or a transitioning military service member under the DOD SkillBridge Internship Program.

• Experience with HEDIS medical record evaluation and abstraction is essential.

• Familiarity with HEDIS, Stars, CMS Quality programs, and healthcare quality metrics is required.

• Prior experience in quality improvement, compliance, or managed care is preferred.

• Must fulfill work-at-home internet requirements: a minimum of 25 Mbps download and 10 Mbps upload speed.

• Must operate from a dedicated workspace that minimizes interruptions to safeguard member PHI/HIPAA information.

• Bachelor's Degree or Equivalent Experience is preferred.

• Active, unrestricted Registered Nurse (RN) or Licensed Practical Nurse (LPN) license in good standing is preferred.

• Experience in reviewing, interpreting, and abstracting information from medical records is preferred.

• Clinical experience in a health plan, physician practice, hospital, or other healthcare settings is preferred.

🏝️ Benefits

• Internship or fellowship opportunities for transitioning military service members and approved military spouses.

• Comprehensive training to prepare for the internship.

• Networking opportunities available during the internship or fellowship.

• Chance to gain civilian work experience while still on active duty.

• Opportunities available that are remote-based, onsite, or field-based depending on the program.

• Self-provided internet service is permissible for work-from-home arrangements.

• Dedicated workspace setup to ensure the protection of member PHI/HIPAA information.