Job Description

Quality Assurance, Clinical Professional 2 Join to apply for the Quality Assurance, Clinical Professional 2 role at Humana . Base Pay Range $65,000.00/yr - $88,600.00/yr Job Overview Become a part of our caring community and help us put health first. The Quality Assurance, Clinical Professional 2 develops and implements programs to establish and maintain quality standards of existing products and services, as well as developing programs to focus associates on the quality of care provided to members. The work assignments are varied and frequently require interpretation and independent determination of the appropriate courses of action. The Quality Assurance, Clinical Professional 2 conducts quality audits to improve the quality of care management services, the member experience and clinical outcomes. Collaborates with other auditors, operations and business partners on quality, process and performance improvement. 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, but receives guidance when needed. Follows established guidelines/procedures. Trains and/or coaches staff and management in areas such as quality improvement, process management and reliability science. Maintains communications with operations and business partners regarding quality assurance activities. Breakdown Of Responsibilities Listen to assigned calls. Review documentation captured as a result of the call. Conduct quality audits using the specified quality audit tool. Assist with focused audits as requested. Work on special projects to improve the member experience and clinical outcomes. Participate in calibration sessions to improve auditing consistency. Assist with education/huddles to help frontline associates improve the quality of their work. Interact with operations and other partners as needed to provide feedback and coordinate quality improvement initiatives. Other duties as assigned to support the improvement and advancement of the quality organization. Required Qualifications RN or Social worker license 4 or more years of clinical experience Excellent organizational skills required Detail-oriented Demonstrated ability to articulate ideas effectively in both written and oral forms Excellent PC skills (including MS Word & Excel) Preferred Qualifications Experience with Humana systems such as: CGX, HCAT, Verint, or Genesys. Previous Quality Auditing Experience Experience in managed care or health care administration desired. Experience reviewing clinical records, calls, and the documentation to evaluate the quality of the service provided. Home or Hybrid Work Requirements At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is required; wireless, wired cable or DSL connection is suggested. Satellite, cellular and microwave connection can be used only if approved by leadership. Employees who live and work from Home in the state of California, Illinois, Montana, or South Dakota will be provided a bi-weekly payment for their internet expense. Humana will provide Home or Hybrid Home/Office employees with telephone equipment appropriate to meet the business requirements for their position/job. Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information. Travel While this is a remote position, occasional travel to Humana's offices for training or meetings may be required. Weekly Schedule 40 hours per week 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. 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 protected veteran status. It is also the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and VEVRAA, to employ and to advance in employment individuals with 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. Senior Level Mid-Senior level Employment Type Full-time Job Function Quality Assurance Industry Insurance #J-18808-Ljbffr Humana

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