Quality Audit Professional 2
Work at Home
The Quality Audit Professional 2 analyzes and investigates quality issues. The Quality Audit Professional 2 work assignments are varied and frequently require interpretation and independent determination of the appropriate courses of action.
The Quality Audit Professional 2 collects and reviews records, summarizes issues, works with Medical director as needed, and implements corrective actions as needed.
- Coordinates Peer review committees.
- Audits quality cases for compliance.
- Understands department, segment, and organizational strategy and operating objectives, including their linkages to related areas.
- Makes decisions regarding own work methods, occasionally in ambiguous situations, and requires minimal direction and receives guidance where needed.
- Follows established guidelines/procedures.
Implements Quality Operations Compliance & Accreditation Program in assigned divisions for all lines of business including Medicare, Commercial, Duals, Medicaid and Special Needs Plans and for multiple products including POS, HMO, PPO, PFFS, ASO, etc.
- 3-5 years clinicaland/orhealth plan experience including 2 years of behavioral health experience
- RN active unrestricted license
- Strong oral / written communication and presentation skills
- Strong analytical skills, able to manipulate and interpret data
- Office practice / hospital experience
- Organizational and prioritization skills
- Comprehensive knowledge of Microsoft Office Word, Excel and PowerPoint
- This role is part of Humana’s Driver safety program and therefore requires an individual to have a valid state driver’s license and proof of personal vehicle liability insurance with at least 100/300/100 limits
- Bachelor’s degree
- Knowledge of HEDIS/Stars/CMS/Quality
- Previous quality or process improvement experience in a hospital or physician office practice
- Strong business skills, including sales and marketing objectives
- Detail orientated and comfortable working with tight deadlines in a fast paced environment
- Ability to work independently under general instructions, self-directed and motivated
Scheduled Weekly Hours: 40