RN, Quality Assurance

Job not on LinkedIn

🔥 0 minutes ago

🇺🇸 United States – Remote

💵 $65k - $88.6k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

🔧 QA Engineer (Quality Assurance)

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👻 Ghost score 0%

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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

• Serve as the clinical subject matter expert for Internal Audit engagements across CenterWell, Care Management, Utilization Management, and other healthcare delivery functions • Partner with audit professionals during audit planning, testing, and reporting • Evaluate key processes, controls, and compliance with regulatory, contractual, and organizational requirements • Review clinical documentation, operational workflows, and quality management activities • Identify potential risks and assess control effectiveness • Recommend process improvements that enhance compliance, quality, and operational performance • Support enterprise-wide improvements in clinical operations, regulatory compliance, and risk management • Travel occasionally to Humana offices for training, meetings, and team engagement activities

🎯 Requirements

• Active, unrestricted RN license • Minimum of 3 years of clinical nursing experience • Demonstrated knowledge of care management, utilization management, population health, or healthcare operations • Experience reviewing clinical documentation, healthcare processes, and operational workflows to assess compliance, quality, and effectiveness • Knowledge of healthcare regulations, accreditation standards, and industry best practices, including CMS, NCQA, URAC, or state and federal requirements • Proficiency in Microsoft Office Suite, including Word, Excel, and PowerPoint • Strong written and oral communication skills • Ability to prepare clear, concise reports and collaborate effectively with stakeholders at all organizational levels • Minimum download speed of 25 Mbps and upload speed of 10 Mbps for home internet • 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