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Humana Senior Quality Compliance Professional in Augusta, Maine

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

The Senior Quality Compliance Professional monitors and completes annual quality reviews and research. The Senior Quality Compliance Professional work assignments involve moderately complex to complex issues where the analysis of situations or data requires an in-depth evaluation of variable factors. The scope of the role includes: process oversight, education/training, quality management support, business SMEs for innovation partnerships, strategic initiative support, and operational expertise for supporting end users.

The Senior Quality Compliance Professional completes medical records reviews for Hybrid and Supplemental data. Analyzes data and implement corrective actions as needed. Begins to influence department's strategy. Makes decisions on moderately complex to complex issues regarding technical approach for project components, and work is performed without direction. Exercises considerable latitude in determining objectives and approaches to assignments.

This is a remote position.

#LI-Remote

Use your skills to make an impact

Required Qualifications

  • 2 years + of Quality HEDIS and supplemental experience

  • RN license

  • 2 years or more of education, training and/or mentoring experience

  • Prior experience in working with quality metrics in a fast-paced insurance or health care setting

  • Comprehensive knowledge of Microsoft Word, Excel and PowerPoint

  • Excellent communication skills, both oral and written

  • Strong relationship building skills

Preferred Qualifications

  • Bachelor's degree

  • Knowledge of Humana's internal policies, procedures and systems

Work-At-Home Requirements:

  • WAH requirements: Must have the ability to provide a high speed DSL or cable modem for a home office. Associates or contractors who live and work from home in the state of California will be provided payment for their internet expense.

  • A minimum standard speed for optimal performance of 25x10 (25mpbs download x 10mpbs upload) is required.

  • Satellite and Wireless Internet service is NOT allowed for this role.

  • A dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information

Additional Information

Interview Format:

As part of our hiring process for this opportunity, we will be using an exciting interviewing technology called HireVue to enhance our hiring and decision-making ability. HireVue allows us to quickly connect and gain valuable information for you pertaining to your relevant skills and experience at a time that is best for your schedule.

If you are selected, you will receive correspondence inviting you to participate in a HireVue assessment. You will have a set of questions and you will provide responses to each question. You should anticipate this to take about 15 - 20 minutes. Your answers will be reviewed, and you will subsequently be informed if you will be moving forward to next round.

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.$76,800 - $105,800 per yearThis 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.

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 because he or she is a protected veteran. It is also the policy of  Humana to take affirmative action to employ and to advance in employment, all persons regardless of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, 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.

Humana complies with all applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, sex, sexual orientation, gender identity or religion. We also provide free language interpreter services. See our https://www.humana.com/legal/accessibility-resources?source=Humana_Website.

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