Description

Humana Healthy Horizons in Indiana is seeking a Manager, Quality Audit who analyzes and investigates quality issues. The Manager, Quality Audit works within specific guidelines and procedures; applies advanced technical knowledge to solve moderately complex problems; receives assignments in the form of objectives and determines approach, resources, schedules, and goals.

Responsibilities

The Manager, Quality Audit collects and reviews records, summarizes issues, works with the Medical Director as needed, and implements corrective actions as needed. The Manager coordinates peer review committees and audits quality cases for compliance.

The Manager, Quality Audit makes decisions that are typically related to resources, approach, and tactical operations for projects and initiatives involving own departmental area. The Manager will collaborate across the department, conducts briefings and area meetings, and maintain frequent contact with other managers across the department.

Required Qualifications

• Must reside in the state of Indiana.
• Bachelor's Degree.
• 6+ years of health care experience.
• 2+ years of management experience.
• Strong communication, analytical, time management and organizational skills.
• Ability to create/pull reports.
• Experience leading and/or facilitating meetings.
• Comprehensive knowledge of Microsoft Office Products, such as Word, Excel, and PowerPoint.

Work at Home Requirements

• At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is recommended; wireless, wired cable or DSL connection is suggested.
• Satellite, cellular and microwave connection can be used only if approved by leadership.
• Humana will provide Home or Hybrid Home/Office associates 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.

Preferred Qualifications

• Registered Nurse, or bachelor/master’s degree in social work.
• Quality investigations experience.
• Clinical Quality Management Experience.
• Certification in Quality.
• Knowledge of NCQA, CMS, and state requirements.
• Passionate about contributing to an organization focused on continuously improving consumer experiences.

Additional Information:

• Workstyle: Remote
• Travel: Up to 25% travel in the state of Indiana to provider offices and Humana locations.
• Core Workdays & Hours: Monday – Friday; typically, 8:00am – 5:00pm Eastern or Central Standard Time
• Benefits: Benefits are effective on day 1. Full time Associates enjoy competitive pay and a comprehensive benefits package that includes 401k, Medical, Dental, Vision and a variety of supplemental insurances, tuition assistance and much more.....

Interview Format

As part of our hiring process, we will be using an exciting interviewing technology provided by Modern Hire, a third-party vendor. This technology provides our team of recruiters and hiring managers an enhanced method for decision-making.

If you are selected to move forward from your application prescreen, you will receive correspondence inviting you to participate in a pre-recorded Voice Interview and/or an SMS Text Messaging interview. If participating in a pre-recorded interview, you will respond to a set of interview questions via your phone. You should anticipate this interview to take approximately 10-15 minutes.

If participating in a SMS Text interview, you will be asked a series of questions to which you will be using your cell phone or computer to answer the questions provided. Expect this type of interview to last anywhere from 5-10 minutes. Your recorded interview(s) via text and/or pre-recorded voice will be reviewed, and you will subsequently be informed if you will be moving forward to next round of interviews.

Social Security Task

Remote Indiana

Scheduled Weekly Hours

40