Quality Compliance Professional

🔥 12 hours ago

🚗 Michigan – Remote

🚗 Michigan – Remote

💵 $71.1k - $97.8k / year

⏰ Full Time

🟢 Junior

🟡 Mid-level

🚔 Compliance

🦅 H1B Visa Sponsor

This company has sponsored H1B visas in the past.

👻 Ghost score 0%

What it means: how likely this posting is sitting open without active hiring.How to read it: 60% or higher means we think this is a ghost. Lower scores are less of a worry.How we score it: age, reposts, open roles vs team size, how fast jobs close, and whether pay is listed.Fine print: an estimate from public data, not a judgment of the company. Real jobs can score high, so treat it as a hint, not a fact.

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Humana

WebsiteLinkedInAll Job Openings

10,000+ employees

Founded 1961

🏥 Healthcare

🛡️ Insurance

⚕️ Healthcare Insurance

Healthcare • Insurance • Healthcare Insurance

Humana is a healthcare company dedicated to making a positive impact on the health of individuals, communities, and the healthcare system as a whole. With a focus on putting health first, Humana serves a diverse range of populations, including seniors and the military, providing Medicare Advantage HMO, PPO, and PFFS plans. Humana is committed to fostering a culture of belonging and mutual respect, offering competitive and flexible benefits to ensure the financial security of its employees and their families. The company prides itself on creating an inclusive workplace where everyone has the opportunity to succeed.

📋 Description

• Collaborate with internal and external customers to meet benchmarks and goals • Complete time-sensitive deliverables for quality clinical and non-clinical projects • Operate as a subject matter expert in Quality Compliance • Complete medical record reviews • Support adherence to regulatory requirements for member and health plan management • Guide and support efforts for successful NCQA accreditation • Analyze data and implement corrective actions as needed • Understand department, segment, and organizational strategy and operating objectives • Make decisions regarding work methods in occasionally ambiguous situations • Follow established guidelines and procedures • Perform additional responsibilities based on business need • Travel occasionally to Humana offices for training or meetings

🎯 Requirements

• Must reside in the state of Michigan • Bachelor's degree • Clinical background • Experience with Long-term service and support (LTSS) populations • Experience with National Committee for Quality Assurance (NCQA) Accreditation • Strong oral, written communication and presentation skills • Strong analytical skills, able to manipulate and interpret data • Office practice / hospital experience • Comprehensive knowledge of Microsoft Office Word, Excel and PowerPoint • Preferred: Registered Nurse (RN) license • Preferred: 2+ years of experience with Long-term service and support (LTSS) populations • Preferred: 2+ years of experience with National Committee for Quality Assurance (NCQA) Accreditation • Preferred: Knowledge of HEDIS/Stars/CMS/Quality • Preferred: Experience with Dual Eligible Special Needs (DSNP) programs • Preferred: Certified Professional in Healthcare Quality (CPHQ) • Preferred: Project Management skills • Preferred: Detail orientated and comfortable working with tight deadlines in a fast-paced environment • Preferred: Ability to work independently under general instructions, self-directed and motivated • Home internet service with at least 25 Mbps download and 10 Mbps upload speed • Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information • Occasional travel to Humana offices for training or meetings may be required

🏖️ Benefits

• Bonus incentive plan based upon 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 • Long-term disability • Life insurance • Home or hybrid home/office work arrangement • Dedicated workspace and internet requirements to support remote work