RN, Quality Assurance

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

📋 Description

• Act as the clinical subject matter expert for Internal Audit engagements throughout CenterWell, Care Management, Utilization Management, and various healthcare delivery functions.

• Collaborate with audit professionals during the phases of audit planning, execution, and reporting.

• Assess critical processes, controls, and compliance with regulatory, contractual, and organizational standards.

• Analyze clinical documentation, operational workflows, and quality management initiatives.

• Identify potential risks and evaluate the effectiveness of controls.

• Suggest process enhancements to improve compliance, quality, and operational efficiency.

• Assist in enterprise-wide initiatives aimed at improving clinical operations, regulatory adherence, and risk management.

• Occasionally travel to Humana offices for training, meetings, and team engagement activities.

⛳️ Requirements

• An active and unrestricted RN license.

• A minimum of 3 years of clinical nursing experience.

• Proven knowledge in care management, utilization management, population health, or healthcare operations.

• Experience in reviewing clinical documentation, healthcare processes, and operational workflows to evaluate compliance, quality, and effectiveness.

• Familiarity with healthcare regulations, accreditation standards, and industry best practices, including CMS, NCQA, URAC, or state and federal requirements.

• Proficiency in Microsoft Office Suite, encompassing Word, Excel, and PowerPoint.

• Excellent written and verbal communication skills.

• Capability to prepare clear, concise reports and effectively collaborate with stakeholders across all organizational levels.

• Minimum internet download speed of 25 Mbps and upload speed of 10 Mbps for home connectivity.

• Ability to work from a dedicated space without ongoing interruptions to protect member PHI/HIPAA information.

🏝️ Benefits

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

• Medical, dental, and vision benefits.

• 401(k) retirement savings plan.

• Paid time off.

• Company holidays.

• Personal holidays.

• Paid parental leave.

• Paid caregiver leave.

• Short-term disability.

• Long-term disability.

• Life insurance.

• Dedicated home workspace arrangement.

• Remote work arrangement.