Remote Quality Auditor Service Coordinator

Humana

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Location: IN
Location Type: Remote
Schedule: Full_time
Req: R-341367

Become a part of our caring community and help us put health first

The Service Coordinator Quality Auditor plays a vital role in auditing vendor agencies providing service coordination to member within the Pathways program. This position involves assessing vendor performance, ensuring compliance with contractual obligations and quality standards, and driving continuous improvement in service delivery. While the primary focus is on auditing vendor operations, the incumbent should also be prepared to provide support in service coordination activities as needed. This ensures the delivery of high-quality services and positive outcomes for our program participants.
The Service Coordinator (Quality Auditor) role involves conducting quality audits and may require onsite visits to vendor agencies throughout the state of Indiana. When supporting service coordination activities, the role will entail meeting members in their location to spend quality time assessing their needs and barriers and then connecting our member with quality services.

 

Position Responsibilities:

  • Conduct audits and evaluations of vendor agencies to assess compliance with contractual requirements, and quality standards.
  • Provide input to improve the quality and effectiveness of service coordination provided by vendor agencies, including developing action plans based on audit findings and implementing process improvements.
  • Provide support, guidance, and training to vendor agencies to enhance their compacity to deliver high quality service coordination.
  • Analyze audit findings, tends and performance metrics to identify areas for improvement.
  • Administer initial and ongoing long-term services and support (LTSS) related assessments through person-centered thinking approaches.
  • Contacts members both telephonically and/or in-person to establish goals and priorities, evaluate resources, develop plan of care and identify LTSS providers and community partnerships to provide a combination of services and supports that best meet the needs and goals of member and caregiver through person centered thinking approaches.
  • Development and continuous modification of Service Plan and involve applicable members of the care team in care planning (Informal caregiver coach, PCP, etc.)
  • Support members through navigation of their LTSS and related environmental and social needs Utilize available information pertaining to member to prevent the need for administration of duplicative assessments.
  • Focuses on supporting members and/or caregivers in accessing long term services and support, social, housing, educational and other services, regardless of funding sources to meet their needs.
  • Build trust and promote independence through a collaborative relationship with the Care Coordinator, member, and caregiver.
  • Identify transition opportunities and work closely with transition coordinators to support member choice.
  • Coordinating with Care Coordinator on referrals for non-capitated services and capturing all services the member is receiving (regardless of payer), including their natural supports.
  • Coordinating and consulting with Humana-contracted providers regarding delivery of LTSS services
  • Participates in interdisciplinary Care team meetings (ICT)
  • Connecting and referring members to community resources and third-party payers
  • Assisting members in maintaining Medicaid eligibility
  • Collaborate with Medical Director/Geriatrician/Care Coordinator as deemed necessary to ensure cohesive, holistic service delivery and support positive member outcomes.

Use your skills to make an impact

Required Qualifications

 

Quality Auditor Service Coordinator must meet one of the following qualifications:

  • Individual continuously employed as a care manager by an AAA since June 30, 2018; OR
  • Registered nurse, a licensed practical nurse, or an associate degree in nursing with at least one (1) year of experience serving the program population; OR
  • Bachelor’s degree in Social Work, Psychology, Counseling, Gerontology, Nursing or Health & Human Services; OR Bachelor’s degree in any field with a minimum of two (2) years full-time, direct service experience with older adults or persons with disabilities (this experience includes assessment, care plan development, and monitoring); OR
  • Master’s degree in Social Work, Psychology, Counseling, Gerontology, Nursing or Health & Human Services; OR
  • Associate degree in any field with a minimum of four (4) years full-time, direct service experience with older adults or persons with disabilities (this experience includes assessment, care plan development, and monitoring).

Must meet all following requirements

  • Previous quality or process improvement experience
  • Prior experiences in health care and/or case management.
  • Intermediate to advanced computer skills and experience with Microsoft Word, Excel, and Outlook.
  • Exceptional communication and interpersonal skills with the ability to build rapport with internal and external customers and stakeholders.
  • Proven ability of critical thinking, organization, written and verbal communication and problem- solving skills.
  • Ability to manage multiple or competing priorities in a fast-paced environment.
  • Ability to use a variety of electronic information applications/software programs including electronic medical records.
  • Must Reside in Indiana (member facing position)
  • Occasionally report to the Indianapolis office for meetings

Preferred Qualifications

  • Bilingual (English/Spanish)
  • Prior nursing home diversion or long-term care case management experience
  • Prior experience with Medicare & Medicaid recipients
  • Experience with electronic case note documentation and documenting in multiple computer applications/systems.
  • Experience working with geriatric population.
  • Experience with health promotion, coaching and wellness.
  • Knowledge of community health and social service agencies and additional community resources
  • Knowledge of HEDIS/Stars/CMS/Quality.
  • Detail orientated and comfortable working with tight deadlines in a fast-paced environment.
  • Ability to work independently under general instructions, self-directed and motivated.
  • Strong analytical skills, able to manipulate and interpret data.

Work-At-Home Requirements

 

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

Workstyle: This is a combination of Work at Home and some member facing visits where needed

Location: Indiana

Training: May 20th 2024 or June 3rd 2024

 

Travel

This position will require some travel in Indiana

  • Must have a Valid driver’s license with reliable transportation and the ability to travel within the state, as required
  • 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 100,000/300,000/100,000 limits.

Screening Requirements

  • This role is considered patient-facing and is part of Humana’s Tuberculosis (TB) screening program.  If selected for this role, you will be required to be tested for TB.

Additional 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 an email correspondence inviting you to participate in a pre-recorded Voice Interview and/or an SMS Text Messaging interview. (please be sure to check your spam or junk folders often to ensure communication isn’t missed) 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 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.

 

 

According to the Indiana Office of Inspector General Rule, 42 IAC 1-5-14 Post-Employment Restrictions, if you are a current or former state officer, employee or special state appointee with Indiana Family and Social Services Administration (FSSA) within the past year, engaged in the negotiation or the administration of a Medicaid contract on behalf of the state and/or Family and Social Services Administration (FSSA); in a position to make discretionary decision affecting the: (1) outcome of the negotiation; or (2) nature of the administration; or either engaged in making a regulatory or licensing decision that directly applied to Humana Inc. or to a parent or subsidiary you cannot be considered for this opportunity. For more information please visit:  IG: Indiana Office of Inspector General

 

Scheduled Weekly Hours

 

40

 

Pay Range

The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc.

 

$63,400 – $87,400 per year

 

This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance.

 

Description of 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.

About us

Humana Inc. (NYSE: HUM) is committed to putting health first – for our teammates, our customers and our company. Through our Humana insurance services and CenterWell healthcare services, we make it easier for the millions of people we serve to achieve their best health – delivering the care and service they need, when they need it. These efforts are leading to a better quality of life for people with Medicare, Medicaid, families, individuals, military service personnel, and communities at large.