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Become a part of our caring community and help us put health first
The Quality Compliance Nurse helps in providing an accurate, timely, and compliant abstraction of medical records to meet HEDIS measurement and reporting requirements as outlined by the National Committee for Quality Assurance (NCQA). The Quality Compliance Nurse Professional 2 performs clinical reviews and supports the staff involved in HEDIS hybrid season review.
The Quality Compliance Nurse works to gain more information about members 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 such as:
Medical record abstraction for HEDIS hybrid measures.
Clinical validation of data elements (e.g., BMI, immunization records, cancer screenings).
Conducting peer-reviews to ensure compliance with NCQA guidelines and organizational standards
Conducting in-depth research on clinical events as assigned (Research Process)
Use your skills to make an impact
Required Qualifications
Registered Nurse (RN) license
Associate's or Bachelor's Degree
Strong clinical background preferably any acute setting such as hospital, physician office practice, or short/long term care institution
Knowledge of chart review/chart extraction
Detail orientated and comfortable working with tight deadlines in a fast-paced environment
Strong analytical skills, able to manipulate and interpret data
Organizational and prioritization skills
Critical thinking, multitasking and flexible in handling various assignments
Strong oral /written communication and presentation skills
Comprehensive knowledge of Microsoft Office Word, Excel, PowerPoint, Outlook, Teams and Zoom
Preferred Qualifications
Electronic Health Records (EHR) experience
Knowledge of HEDIS/Stars/CMS/Quality
Previous quality or process improvement experience in any acute setting such as hospital or physician office practice, and long-term care institution.
Ability to work independently under general instructions, self-directed and motivated
Additional Information
Variable Staffing Pool (VSP) : Associates who work flexible hours based on business needs. There is no guaranteed minimum or maximum number of hours in any week, and no guaranteed length of employment. Benefits are not offered for VSP roles.
Work Days : Monday-Friday ( Business hours, 40/hrs. per week ); hours are not guaranteed with VSP roles.
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.$69,800 - $96,200 per year
Description of Benefits
Humana, Inc. and its affiliated subsidiaries (collectively, 'Humana') offers benefits for limited term, variable schedule and per diem associates which are designed to support whole-person well-being. Among these benefits, Humana provides paid time off, 401(k) retirement savings plan, employee assistance program, business travel and accident.
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.
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 veteran status. It is also the policy of Humana to take affirmative action to employ and to advance in employment, all persons regardless of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, 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.
Humana complies with all applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, sex, sexual orientation, gender identity or religion. We also provide free language interpreter services. See our https://www.humana.com/legal/accessibility-resources?source=Humana_Website.