Quality Compliance Professional

🔥 1 minute ago

🌴 South Carolina – Remote

🌴 South Carolina – Remote

⏱ Part Time

🟡 Mid-level

🟠 Senior

🚔 Compliance

🦅 H1B Visa Sponsor

This company has sponsored H1B visas in the past.

👻 Ghost score 10%

What it means: the chance that no one is really hiring for this job.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

• Complete annual quality reviews and research • Complete medical record reviews for Coordination of Care studies • Analyze data and implement corrective actions • Review medical records for supplemental data • Enter supplemental data into the supplemental database • Interpret and independently determine appropriate courses of action within varied work assignments • Understand department, segment, and organizational strategy and operating goals • Follow established guidelines and procedures • Partner with the team to support members and projects and meet goals affecting outcomes • Support and facilitate care for members • Participate in internship or fellowship networking opportunities • Occasionally travel to Humana offices for training or meetings

🎯 Requirements

• Must be a current military spouse approved for a spousal internship or a transitioning military service member under the DOD SkillBridge Internship Program • Experience with HEDIS medical record review and abstraction • Knowledge of HEDIS, Stars, CMS Quality programs, and healthcare quality measures • Previous quality improvement, compliance, or managed care experience • Must meet work-at-home internet requirements: minimum 25 Mbps download and 10 Mbps upload speed • Must work from a dedicated space lacking ongoing interruptions to protect member PHI/HIPAA information • Bachelor's Degree or Equivalent Experience (preferred) • Active, unrestricted Registered Nurse (RN) or Licensed Practical Nurse (LPN) license in good standing (preferred) • Experience reviewing, interpreting, and abstracting information from medical records (preferred) • Clinical experience in a health plan, physician practice, hospital, or other healthcare setting (preferred)

🏖️ Benefits

• Internship or fellowship opportunities for transitioning military service members and approved military spouses • Main training to perform the internship • Networking opportunities during the internship or fellowship • Opportunity to gain civilian work experience while still on active duty • Remote-based, onsite, or field-based opportunities depending on the program • Self-provided internet service may be used for work from home • Dedicated workspace arrangement to protect member PHI/HIPAA information

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