Group Health QA Supervisor - RN
Blank StreetSalary not specified
- Full Time
- Junior (1 to 2 years), Junior (1 to 2 years)
Not SpecifiedCompensation
Junior (1 to 2 years)Experience Level
Full TimeJob Type
UnknownVisa
HealthcareIndustries
Requirements
Candidates must be a U.S. citizen and able to obtain interim government security clearance, possess a current RN license in their state of employment, and have at least three years of clinical RN experience along with two years of experience in Utilization Review, Case Management, or Quality Management. Strong analytical skills and the ability to manipulate and interpret data are required, as is the ability to work specific timeframes.
Responsibilities
The Quality Audit Professional 2 analyzes and investigates quality issues, collects and reviews medical records, creates case summaries, presents potential quality issue (PQI) cases to Medical Director for review, provides assistance to Medical Directors, monitors corrective action plans (CAPs), monitors cases in the Clinical Quality Management Database (CQMD), participates in case presentations at the Patient Safety Peer Review Committee (PSPRC), reviews PQI’s from all sources, and participates in departmental projects such as focused reviews. They also coordinate case presentations and may travel to Humana’s offices for training or meetings.
Skills
Medical Records Review
Quality Assurance
Clinical Quality Management
Data Entry
Case Presentation
Corrective Action Planning
Healthcare Compliance
Peer Review Process
Humana
Health insurance provider for seniors and military
About Humana
Humana provides health and well-being services, focusing on Medicare Advantage plans for seniors, military personnel, and communities. Their plans include HMO, PPO, and PFFS options, designed to improve health outcomes through comprehensive and flexible coverage. Humana's revenue comes from government contracts and member premiums, and they aim to maintain high renewal rates by offering quality service and competitive benefits. The company stands out by fostering a culture of inclusivity and belonging among its employees, while also ensuring accessibility for all members, including offering free language interpreter services. Humana's goal is to deliver value to its members through an extensive provider network and innovative health solutions.
Key Metrics
Louisville, KentuckyHeadquarters
1961Year Founded
IPOCompany Stage
Social Impact, HealthcareIndustries
10,001+Employees