Remote Quality Audit Professional RN, OH

Location:Cincinnati, OH
Location Type:Cincinnati – Remote
Additional Location: CT; DE; FL; GA; IN; KY; ME; MD; MI; NH; NJ; NY; NC; PA; TN; VT; VA; WV;
Schedule: Full_time
Req: R-313637

Description

Job Description Summary
Humana Healthy Horizons in Ohio is seeking a Quality Audit Professional 2. This position ensures mandatory reporting is completed. Conducts and summarizes compliance audits.

You will be part of a caring community at Humana.
When you meet us, you can tell we started as a hometown company. We’re proud of our Louisville roots and, as we’ve grown, that community feeling has spread across all 50 states and Puerto Rico. No matter where you are—whether you’re working from home, from the field, from our offices, or from somewhere in between—you’ll feel welcome here. We’re a caring community made of close-knit teams, cross-country friendships, and inclusive resource groups, all gathered around one big table where everyone’s voice is heard and respected. Community is a verb here. It’s up to each of us to care for it and maintain it. Because the relationships we form will help us deliver better health outcomes for the people we so proudly serve.

Are you Caring, Curious and Committed? If so, apply today!

Responsibilities

The Quality Audit Professional 2:

• Collects and analyzes data daily, weekly, monthly, or as needed to assess outcome and operational metrics and trends for the Behavioral Health team and individuals
• 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
• Requires minimal direction
• Receives guidance where needed
• Follows established guidelines/procedures

This is a remote position

#LI-Remote

#LI-MH1

Required Qualifications

• Licensed Behavioral Health Professional or Active Registered Nurse (RN) in Ohio or a compact license with no disciplinary action
• 3 years’ experience working in behavioral health setting: community, facility, academia, or managed care
• 1 year Case Management experience
• 1 year compliance  or quality auditing experience
• Proficient with Microsoft Office products including Word, Excel and Outlook
• Ability to work independently under general instructions and with a team
• Must be passionate about contributing to an organization focused on continuously improving consumer experiences

Preferred Qualifications

• Master’s Degree
• Previous health plan and/or Medicare/Medicaid experience
• Previous experience or knowledge of NCQA accreditation requirements

Additional Requirements/Adherence

• Workstyle – Remote work at Home
• Location: Primary Ohio
• Alternate Locations: Eastern Time Zone United States
• Work Days/Hours: Monday – Friday; 8:00am – 5:00pm EST.
• Travel: 5-10% travel in Ohio as needed to support business needs.

Additional Information

About Humana

Your growth is what drives Humana forward.

• When you get here, the journey is just beginning. Our leaders are committed to understanding what you need to grow. Because we don’t grow without you
• This is a place where our nurses influence the C-suite
• Where software engineers change lives
• Where every associate can build a professional path where they learn and thrive
• Through our commitments to wellbeing and work-life balance, we support each associate’s personal health, purpose, work style, sense of belonging, and security
• Because finding new ways to put health first—for our members and patients and our associates alike—is what we do

Work at Home Guidance

To ensure Home or Hybrid Home/Office associates’ ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office associates must meet the following criteria:

• 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
• Associates 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 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

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.

Scheduled Weekly Hours

40