Quality Improvement Professional

Humana — Remote Indiana

Become a part of our caring community Humana is looking for a Quality Audit/Improvement Professional who will audit and monitor quality improvement programs for Humana's Indiana Pathways and LTSS program. The Quality Improvement Professional's work assignments are varied and frequently require interpretation and independent determination of the appropriate courses of action. Position Responsibilities: Audits charts and processes for compliance. Audit records for quality of care and compliance with regulatory requirements. Complete and submit reports to CMS and state regulators for clinical studies. Analyze audit data for reporting to manager. Understand department, segment, and organizational strategy and operating goals, including their linkages to related areas. Complete other assignments and participate in other projects as departments' needs arise. Participate in interdepartmental activities. Use your skills to make an impact Required Qualifications Two (2) years of relevant experience in health insurance or health care OR two (2) years of relevant experience in auditing. Experience learning new software programs and systemst Preferred Qualifications Bachelor's degree. Audit experience in a healthcare setting. Knowledge of Humana's internal policies and systems. Experience with Long-term Care programs. Registered Nurse, Licensed Practical Nurse (LPN), or Master's/Bachelor's in social work. Knowledge of HEDIS/Stars/CMS/Operational Quality. Previous quality or process improvement experience in a hospital or physician office practice. Additional Information Workstyle: Home. We define home workstyle as remote but will use Humana office space for collaboration and other face-to-face needs. Typical Work days/hours : Monday – Friday, 8:00 am – 5:00 pm Eastern Standard Time (EST) 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 t

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